I the undersigned declare and I hereby warrant that the above statement and particulars are true and I hereby agree that declaration shall be deemed to be of a promissory nature and effect and the basis of the contract between me and the Company and that I have not withheld any important information which should be communicated to the Company and that I am willing to accept a policy subject to the terms, conditions and exceptions therein and to pay the premium agreed upon.

I/we do hereby confirm that I/we have authorized Bunna Insurance S.C. to share my/our credit information and to access my/our credit profile from Credit Reference Bureau (C.R.B)