We would remind you that it is necessary for every Insured to disclose to Insurers immediately any information, including changes in circumstances, which might affect the judgement of the Insurers in assessing the risk or the premium, and failure to disclose such information or changes could void the insurance contract.
Signing this proposal form does not bind you to complete the insurance, but it is understood and agreed that this proposal shall form the basis of the contract should a certificate be issued.
I have read the above. I agree that to the best of my knowledge and belief it represents a true statement, and any additional information that may reasonably be considered by insurers as material information has been disclosed separately to this proposal.