OBF

Step 1 of 4

Please tick the boxes to confirm that you agree with the following statements. If there are any which you can't agree with, please contact us on 01 6601033 or email info@obf.ie.

I have never had any claims made against me.

I have not been subject to nor have any pending disciplinary hearings against me

I am not aware of any incidents that have occurred which may have given rise or may give
rise in the future to a claim under the policy

I have never had suits for negligence, error or omission made against me

Under current or any previous trading titles, I have never been convicted of any criminal offence,other than motoring, nor have any prosecution pending

I hold approved qualifications to carry out the treatments I have requested cover for and I understand that in the event of a claim being reported proof of such qualifications will be required prior to indemnity been confirmed.

No insurer has ever cancelled, declined, refused to renew or only accept on
special terms, my liability insurance

I do not undertake any work within the USA or Canada and undertake no more than 90 days of
work outside of Ireland, the United Kingdom, Isle of Man or the Channel Islands.

I have read and agree to the terms of business of OBF Insurance Group Ltd. Read here

I have read the notes applicable to the policy Read Notes

Step 2 of 4

Step 3 of 4

Choose your treatments

Step 4 of 4

Data Protection - Information Uses

For the purposes of the Data Protection Act, OBF Insurance Group Ltd. (the Company) is the Data Controller in relation to any personal data supplied by you (being the insured person(s) specified in this proposal). Information you supply may be used for the purposes of insurance administration (including underwriting, processing, claims handling, reinsurance and fraud prevention) by the Company and its agents, by reinsurers and your intermediary. In assessing any claims made, insurers may undertake checks against publicly available information such as electoral roll, court judgements, bankruptcy and repossessions. We may share with other insurers/their agents, intermediaries acting for you and recognised trade, governing and regulatory bodies (of which we are am member or by which we are governed), information we hold about you and your claims history.

Declaration

I/we declare that the above statements are true in every respect. I/we hold qualification certificate(s) for the therapy(ies) stated in this proposal form. I/we have not withheld or misrepresented any material fact. I/we agree that this proposal will form the basis of the contract between me/us and OBF Insurance Group Ltd.