You declare and warrant that after enquiry all statements and particulars contained in this Proposal and addendum are true and that no information whatever has been withheld which might increase the risk of The Company or influence the acceptance of this Proposal and should the above particulars alter in any way you will advise The Company as soon as practicable.
You understand that failure to disclose any material facts which would be likely to influence the acceptance and assessment of this Proposal may result in The Company refusing to provide indemnity or voiding the Policy in every respect. You hereby agree and accept that this Declaration shall be the basis of the contract between both parties if entered into.
You confirm that as of the date hereof you have appointed All Med Pro as your exclusive Insurance Broker with respect to the above coverage. The appointment of All Med Pro rescinds all previous appointments and the authority contained herein shall remain in full force until cancelled in writing.