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Declaration

I/We hereby declare that the particulars on this form are true. I/We acknowledge that any misleading, false or untrue statement, will mean that my/our claim will not be paid.

Data protection notice

By submitting this form you are giving permission to contact you regarding your insurance quote.

Your information has been, or will be, collected or received by MS Amlin plc. We will manage personal data in accordance with data protection law and data protection principles. We require personal data in order to provide good-quality insurance and ancillary services and will collect the personal data required to do this. This may be personal information such as name, address, contact details, identification details, financial information and risk details. Please refer to the data privacy Notice for more details.

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