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Children's Personal Accident Insurance Statement of Facts Underwritten by Groupama Insurance Company Limited

Important Notice

This Statement of Facts is a record of the information and Material Facts advised to Groupama Insurance Company Limited upon which the acceptance of the proposal for insurance and the calculation of the premium are based and which form the basis of the contract of insurance between the Insured and Groupama Insurance Company Limited. A material Fact is one which an insurer would regard as likely to influence their assessment and acceptance of this insurance.

Please check this statement carefully and if any of the information is incorrect or if there are any other material facts which need to be disclosed please advise Russell Scanlan Ltd immediately. Failure to do so could invalidate your policy or result in a claim being repudiated.

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Please Tick The Cover Required

  •   (1 child - £30, 2 children - £50, 3 to 5 children - £70)
  •   (1 child - £50, 2 children £80, 3 to 5 children - £120)
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Premium (All premiums include Insurance Premium Tax)

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  •   Select Date  for 12 months

Declaration

    I declare that, to the best of my knowledge and belief, the child/children named above is/are in good health and I have no reason to believe that any ailment or condition exists which might require medical advice or treatment.

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Note:

  1. Our liability does not commence until this proposal has been accepted and the first premium paid.
  2. Please advise any additional relevant information in the above box
  3. Any occurrence affecting your children's health after signing this proposal and before cover commences must be disclosed.
  4. The details you are being asked to supply may be used to provide you with information about other products and services Russell Scanlan Limited can offer.
    Please tick if you do not wish to receive such information
  5. Please keep a record (including copies of letters) of all information supplied to the Insurer for the purpose of entering into this contract.
  6. For Data Protection Act purposes your personal data will be held and processed for insurance administration. For this purpose the information may also be passed to selected third parties including other insurers, credit referencing agencies and reinsurers. By entering into this contract of insurance your insurance advisor who arranged this contract of insurance on your behalf has confirmed your authority to disclose your personal data and to consent on your behalf to the processing of that data by Groupama Insurance Company Limited.

You have the right to access (subject to limited exceptions) and if necessary rectify the information that we hold.

Insurers pass information to the Claims and Underwriting Exchange register and the Motor Anti-Fraud and Theft Register. These registers have been established to help check the information provided and also to reduce fraudulent claims. These registers may be searched when dealing with any request for insurance. Under the conditions of the policy, all incidents must be declared whether or not they may result in a claim. The information may be passed to the registers.

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