Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Assessment Declaration
I declare that the statements and particulars in the IASME / Cyber Essentials assessments are true and that no material facts have been misstated. A material fact is one which would influence the acceptance or assessment of the risk. I agree that this declaration together with any other information supplied shall form the basis of the Contract of Insurance (included in this assessment package) effected thereon. I undertake to inform the insurers of any material alteration to the facts [occurring before the completion of the contract of insurance]. A material fact is one which would influence the acceptance or assessment of the risk. I also declare to have read the applicable wording (1) and fully understood its scope, exclusions and limitations.
Company Name as registered with Companies House *
…………………………………………………
Signatory Name (Board Level or Equivalent) *
…………………………………………………. (Please Print Full Name (no initials))
Job Title *
…………………………………………………
Signature *
…………………………………………………
Date *
…………………………………………………
(1) Policy Document Wording
* Completion of all fields required before the insurance policy documents can be issued