By completing and submitting this proposal form,
I/we declared that to the best of my/our knowledge and belief these particulars are true, complete and correct. Subject to any right I/we have under the Clean Slate Act, I/we have not withheld any information or any other material fact likely to affect the provision of cover by Nautical / Vero Marine Limited.
I/We declare that:
1. Subject to any right I/we have under the Clean Slate Act, the information given is in every respect correct and complete and all material information, including details of previous losses/claims, has been disclosed to Nautical/Vero Marine;
2. I/we undertake to exercise all ordinary and reasonable precautions for the safety of the items insured;
3. This application shall be the basis of the contract between Nautical/Vero Marine and myself/ourselves; and I am/we are willing to accept cover subject to Nautical/Vero Marine’s policy terms, conditions, exclusions and any special terms they may require;
4. The figures shown represent the current market value on the New Zealand market, or if less than 3 years old, the replacement value;
5. I/We are fully authorised to complete and sign this application on behalf of the person(s) named in the proposal.
I/We authorise:
1. Nautical/Vero Marine to give and obtain from other insurance companies, insurance brokers, the Insurance Claims Register Ltd or any other party any information relating to this or any other insurance held or previously held by me/us and any claim(s) made by me/us.
I/We undertake to inform Nautical/Vero Marine immediately of any material events or changes in circumstances which occur after the commencement of this policy and whenever the contract is varied or renewed. This insurance will not be in force until this proposal has been accepted by Nautical/Vero Marine.