Employers’, Public and Products Liability Proposal Form
Please answer all questions as fully as possible.
Material contained in the Proposer’s website is not deemed to form part of this proposal apart from any information attached to the proposal in hard copy form.
The form must be signed and dated by a Director or suitably authorised individual.
In the case of a group, co-op, community event or similar, a nominated organiser or appointed representative is required to complete this form. Individual members’ details can then be supplied on the basis of the group information.
Our limits of Indemnity for Public, Products and Employers Liability is €13 million.
All applicants or an appointed representative must sign and date the declaration
Law Applicable to Contract. This Contract will be subject to Irish Law.
Data Protection Act 2003
We may store your information on a computer and use it for administration, risk assessment, research and statistical purposes, marketing purposes and for crime prevention (see further details below). We will only disclose your personal details to third parties if it is necessary for the performance of your contract with us.
In order to assess the terms of the insurance contract or administer claims which arise, we will need to collect data which the Data Protection Act defines as sensitive such as medical history or criminal convictions. By proceeding with this contract you will signify your consent to such information being processed by the Insurers or the agents.
We will keep your information secure at all times. In certain circumstances, for example for systems administration purposes, we may have to transfer your information to another country, which may be a country outside the European Economic Area (EEA). By proceeding with your insurance application, we will assume you are agreeable for us to transfer your information to a country outside the EEA.
Should you wish to receive a copy of the information we hold on you please contact:
IOMST, Bushfield House, Bushfield Square, Philipsburgh Avenue, Fairview, Dublin 3.
Ph 01-8360945/01-8360952 email: email@example.com
This insurance will be underwritten by AIG Europe Limited, a firm authorised and regulated by the Central Bank.
Registered Office: 30 North Wall Quay, IFSC, Dublin 1.
Tel: 020 7860 6600 Fax: 020 7860 6290
Registered in Rep. of Ireland