Details of Cover
C & F, FOB or similar purchases. (You are responsible to insure)
CIF or similar exports. (where you are responsible to insure)
Within Australia & shipments to FOB
World to World
(where you are responsible to insure)
Travellers samples / stock in vehicles
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I/We hereby declare that:
- My/Our attention has been drawn to the Important Notice accompanying this Proposal form and further I/we have read these notices carefully and acknowledge my/our understanding of their content by my/our signature/s below.
- The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter between the date of this Proposal form and the inception date of the insurance to which this Proposal relates I/we shall give immediately notice thereof.
- I/We authorise Austbrokers Countrywide to collect or disclose any personal information relating to this insurance to/from any other insurers or insurance reference service. Where I/We have provided information about another individual (for example, an employee, or client),
- I/We declare that the individual has been or will be made aware of that fact and the section in the Policy on “The way we handle your personal information”.
- I/We also confirm that the undersigned is/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this Proposal form and I/we complete this Proposal form on their behalf.
- I/We declare that where we declare our turnover less than $2million that I/we are a small business eligible for the exemption from the requirement to pay duty on certain types of insurance under section 259B of the Duties Act 1997 (NSW).
- To be signed by the Chairman/President/Managing Partner/Managing Director/Principal of the association/ partnership/company/practice/business.
- It is important that the signatories to the Declaration are fully aware of the scope of this insurance so that all questions can be answered. If in doubt, please contact us since non-disclosure may affect an Insured’s right of recovery under the policy or lead to it being voided.
Time Stamp 10/06/2023
User IP Stamp 220.127.116.11
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