You must give true and full answers to all the questions. If you do not do so, your insurance cover may not protect you in event of a claim. Axa General Insurance Limited is a member of the Axa Group. To set up and administer your policy we will hold and use information about you supplied by you. We may send it in confidence for processing to other companies in the Axa Group (or companies acting on our instructions) including those located outside the European Economic Area. By signing this form you consent to such use of your personal data. Axa Insurance UK plc may send you details of other products and services. To enable them to send you details of their services we may also share your name and address with other Axa Group companies based within the European Economic Area and with other carefully selected companies outside the Axa Group. You may be contacted by phone, fax or E-mail if appropriate. If you do not wish to receive such details please tick box.

You and we are free to choose the law applicable to this contract. In the absence of an agreement to the contrary the law of England and Wales will apply. If you reside in (or in the case of business, the registered office/principal place of business is in) Scotland, Northern Ireland, the Channel Islands or the Isle of Man the law applicable to that appropriate country will apply. Upon acceptance of the risk a copy of this proposal form will be returned with the policy document.