GN PI Proposal Form Veterinarians 9.22 (TR)

Disclosure: Veterinarians and Veterinary Practices

You must disclose to the underwriters all information which is material to it in deciding whether to provide insurance cover to you, including any facts or conduct which might lead to a claim being made against you. Failure to do so could affect your cover. If you are in doubt, then rather disclose.

If you do not understand any part of this document, please contact your broker prior to signing it. You will be bound by the answers which are given, and by the information provided by you in this proposal form. It is, therefore, in your interests to make sure that all information is correct and understood.

This proposal form will be submitted on your behalf to the Underwriters and has been compiled in such a manner as to provide it with as much detail as possible to enable them to evaluate the risk. Completion of this form does not bind either you or the Underwriters r to complete the insurance transaction.

To assist the Underwriters in accurately assessing liability for rating purposes, you are requested to answer all the questions. Where a mark is required, please mark the appropriate box with an “X”.

Please answer ALL questions fully. Please note, replies such as “see your records”, or “as previously advised” are not acceptable. If the space provided is insufficient, a separate sheet should be attached.

PLEASE NOTE: You acknowledge that the personal information you supply is provided voluntarily and therefore constitutes specific, voluntary consent to the processing of such information by the Underwriters and the Insurer. Your personal information will be processed for:

  • general and specific underwriting and risk assessment purposes
  • Statistical research and / or reporting
  • The legitimate interests of the Underwriters and the Insurer and / or yourself
  • Any statutory or regulatory compliance (where applicable)

The following documents must be returned with this proposal:

  1. Company information
  2. Claims information
  3. Latest audited financial statements/ details of annual income
  4. A copy of the expiring schedule of cover so that retroactive cover can be validated