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    Additional Driver Proposal Form

    Unless all material facts are disclosed, the insurance could be invalidated. Material facts are those facts an Insurer would regard as likely to influence the acceptance and/or assessment of the proposal. If you are in any doubt about whether facts are material, you should disclose them.

    All questions must be fully answered, in block capitals or by circling the NO / YES answers
    Have you:
    I/We declare that the above statements made by me/us or written in answer to the questions on this form on my/our behalf by someone else are to the best of my/our knowledge and belief true and correct, and no material fact has been misrepresented, misstated or withheld.
    I/We agree that this form, in conjunction with the original proposal, be incorporated in and taken as the basis of the contract between me/us and the Insurers and will be deemed as incorporated in the policy.
    I/We agree that electronically transmitted signatures affixed to this document shall have the force and effect of original signatures