APPLICANT'S CONSENT TO THE TRANSMISSION OF THE INFORMATION CONTAINED IN THE APPLICATION FORM
I hereby acknowledge that the information collected in the Application form is acquired by my insurance broker to be trasmitted to ENCON Group Inc. for the sole purpose of obtaining an insurance policy and will be kept confidential.
Moreover, I authorize ENCON Group Inc., its insurers or service providers to:
1. conduct verification, using outside sources, of the information contained in the Application form, in attached documentation and in subsequently provided documentation.
2. in the event of a claim, transmit the submitted and verified information to loss adjusters, lawyers or other similar offices for the purposes of investigating, defending, negotiating or settling any claims, as required.