| I hereby declare that I am the policy holder andI entered all fields by my self | It is also understood that the insurer reserves the right to request any document to proof the information that I entered, also the right to cancel the policy and forfeit the premiums paid in case identification particulars are not found correct |
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| I declare that the documents submitted for identification are original and all particulars given are true and correct | I hereby declare that to the best of my knowledge and belief, the above statements and particulars are complete and true and that I have not misstated or suppressed any material facts a material fact is one which is likely to influence Tawuniya's acceptance or assessment of this proposal |
If in any doubt whether facts are material, they shouldbe disclosed.
23| Tawuniya reserves the right to decline any application | Submitting this form does not bind the applicant to complete the Insurance, nor Tawuniya to accept, but it is agreed that this form shall be the basis of the contract should a policy be issued |
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| Your Quotation code is : Back to Tawuniya Store | If any doubt whether facts are material, they should be disclosed |
Declaration by Applicant on behalf of all Persons to be Insured• To the best of my knowledge and belief, the above statements and particulars are complete and true and that I have not misstated or suppressed any material facts.
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