I declare that the information provided in this form is true and correct. I understand that any false or misleading information may result in my membership being voided. I consent to my personal information being used for the purpose of administering my membership and policy.

By signing this application form, the policyholder expressly consents to the potential transfer of the policy to an alternative registered underwriter at any time during the policy term. Such transfer may be effected without the need for further consent from the policyholder, provided that the intermediary undertakes to ensure continuity of cover. All material rights and obligations under the policy will remain unchanged unless otherwise communicated in writing.