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I, the undersigned, whose life is proposed for assurance, do hereby declare that the statements in this proposal are true and complete and hereby consent to the Company seeking any information it deems necessary from any hospital, clinic or doctor who has at any time attended to me seeking information from my bankers and employers and from any insurance to which a proposal for the assurance of my life has been made, and I authorize the giving of such information. I further agree that this proposal and Declaration and the statements made above or to the Medical Examiner acting for the Company shall be the basis of the proposed contract between the Company and myself, that if anything contrary to the truth be stated or if any information which ought to be made known to the Company with reference to the Proposed Assurance to be withheld or, concealed and policy which may be granted in pursuance of this proposal Shall be null and void.
By completing this form, I give permission for my personal information and that of my beneficiary to be held in Nassure Microinsurance Limited database and agree that Nassure Microinsurance Limited may process my personal data relating to me in the manner specified in her Privacy Policy. (visit our data protection policy on: https://nassuremicroinsurance.com/policy/privacy I/We agree that this declaration shall be the basis of the contract between me/us and the company.