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*S’il n’y a pas de service de boissons alcooliques, procéder à la question #14

I / We declare hereby that the answers and above statements, whether written of my / our own hand or not, are true and I guarantee / we guarantee that no material has been withheld or misstated and I / We agree that if a policy was established, this proposal form will be attached and form part of and basis for the contract with subscribers. I / We agree that the answers and statements must constitute significant guarantees issued any police. I / We understand that subscribers may declare void any policy issued in the event of misrepresentation, omission or reluctance in proposal form, whether made intentionally, accidentally or innocently. I was advised / We have been informed by the broker and I / We consent to the collection, the appropriate use and disclosure to third parties any information that could be perceived as a personal information.

Please note that this document is an application form, this document is not an insurance policy. Insurance enter into force only in the policy or certificate issue date specifically authorized by the company or by the agency. The ratings will be based on the information provided and the guarantees of the applicant.

Please, make sure that all questions are completed.
If a question does not apply to the event, answer with s/o.