Worklife Contractor Declaration


i2i Brokers are bound by the obligations of the Privacy Act 1993 regarding the collection, use, disclosure and handling of your personal information.  We will protect the privacy of your personal information.  We will use the information you provide in this Declaration Form to consider your application for insurance under Worklife's Indemnity programme, to determine any special policy terms, to assess a claim, etc.

We will disclose this information to Worklife's Indemnity insurer, Delta Insurance who will use your information for the purposes we provided it to them (or if required by law)

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Prior history


THIS FORM NEEDS TO BE COMPLETED IN ITS ENTIRETY. Cover will not be provided unless all questions have been answered. Incomplete Declarations will be sent back for resubmission.