«SAFEHOME SELECT PROPOSAL THIS DOCUMENT FORMS THE BASIS OF YOUR CONTRACT This document is a record of the information advised to RSA Insurance Ireland ...»
SAFEHOME SELECT PROPOSAL
THIS DOCUMENT FORMS THE BASIS OF YOUR CONTRACT
This document is a record of the information advised to RSA Insurance Ireland Limited (RSA) for the purposes of
concluding a contract of home insurance. The information provided within this proposal and declaration shall form
the basis of the contract between you and RSA. The questions on this form are required to provide us with sufficient
information to underwrite this insurance. This information will be taken into account when calculating the premium and applying terms and conditions to your insurance policy.
Failure to disclose all material information, or disclosures of false information could result in:
• The policy becoming void
• A claim not being paid
• Claims paid being recovered from you
• You becoming liable for additional premiums which we reserve the right to collect
• Terms and conditions of the policy being amended Material information is any fact that RSA would regard as likely to influence the acceptance or assessment of the risk which includes for example, past claims made or submitted by you or any member of your household, including losses suffered by you or any member of your household, whether insured or not.
If you are in any doubt whether a fact is material you should disclose it.
Should we take any of the aforementioned actions against you, you will be obliged to disclose this fact on any future request when seeking a quotation and / or cover. Such action by us is considered as the application of 'terms' / 'special terms' and may affect your ability to get insurance cover in the future. Furthermore, failure to have property insurance in place could lead to a breach of the terms and conditions attaching to any loan secured on the property.
It is recommended that you keep a record (including copies of letters) of all information supplied for the purpose of this insurance.
Please also read the Declaration and Important Notes overleaf.
FOR INTERMEDIARY USE ONLYIntermediary Name Agency Code Premium Incl. Government Levy
THIS PRODUCT IS FOR OWNER - OCCUPIED / MAIN RESIDENCE POLICIES ONLYRSA Insurance Ireland Limited (herein referred to as 'RSA')
PLEASE ANSWER ALL QUESTIONS.
USE BLOCK CAPITALS THROUGHOUT. TICK BOXES WHERE APPROPRIATE TO CONFIRM YOUR SELECTION.
USE A SEPARATE SHEET IF ANSWER SPACE IS INSUFFICIENT.
Inception Date of Cover You Name (Mr/Mrs/Ms/Miss) Occupation Date of Birth Name
Additional Insured Name:
Phone NumberMobile Daytime Evening
Address to be Insured: Postal Address (if different):
Why is the postal address different? (See Declaration overleaf) Is the Property in an area
Is the Property within 100 metres of any other property or development, which has been subject to flooding? Yes No
If you have ticked 'Yes' to this question please provide full details:
Is the Property within 100 metres of any lake, river, stream, canal, sea, turlough, dam or any other body of water? Yes No
If you have ticked 'Yes' to this question please provide full details:
Is the property currently under Construction, Renovation, Redecoration or Extension?
If you have ticked 'Yes' to this question please provide full details, together with details of occupancy Yes No
during this period:
Is the Property roofed with slates, tiles, concrete, metal (other than corrugated iron), asphalt or a flexible weathering membrane, provided that the membrane portion of the roof does not exceed 50% of the total roof area? Yes No
If you have ticked 'No' to this question, please provide full details of the construction of the roof including the percentage of nonstandard construction:
If any portion of the roof is covered with a flexible weathering membrane, please provide details as to when it was last re-done, the percentage of the total roof area that is covered in this material, composition of membrane / material and what is laid on (example timber and felt):
What is the approximate year of construction of the Property?
If built pre 1920, please confirm when the Property was last:
(a) Fully re-roofed:
(b) Fully rewired:
(c) Fully re-plumbed:
Regarding (a), (b) and (c) above: if any of the work carried out was partial rather than in full, please provide precise detail of the
work carried out:
Number of Bedrooms?
Number of Bathrooms/Ensuite/WC in total?
If the land surrounding the Property exceeds 1 acre please specify the total number of acres and what it is used for:
DATA PROTECTION NOTICE
Please read the following carefully as it contains important information relating to the information that you give us or has been provided to us on your behalf. If you provide information relating to anyone other than yourself, you are responsible for obtaining their consent to the use of their data in the manner outlined below.
What Does RSA do with Your Personal Data Information you provide will be used by RSA for the purposes of processing your application and administering your insurance policy. RSA may need to collect sensitive data relating to you (such as medical or health records or convictions) in order to process your application and/or any claim made.
All information supplied by you will be treated in confidence by RSA and will not be disclosed to any third parties except (a) to our agents, sub-contractors and re-insurers (b) to third parties involved in the assessment, administration or investigation of a claim, (c) where your consent has been received or (d) where permitted by law. In order to provide you with products and services this information will be held in the data systems of RSA or our agents or subcontractors.
RSA may pass your information to other companies for processing on its behalf. Some of these companies may be based outside the EEA, but in all cases RSA will ensure that its transfers of data are lawful and that your information is kept securely and only used for the purposes for which it was provided.
Calls to RSA may be recorded for quality assurance or verification purposes.
Fraud Prevention, Detection & Claims History
In order to prevent and detect fraud and the non-disclosure of relevant information RSA may at any time:
• Share information about you with companies within the RSA Insurance Group, other organisations outside the RSA Group including where applicable private investigators and public bodies including An Garda Síochána;
• Check and / or file your details with fraud prevention agencies and databases, and if you give us false or inaccurate information and we suspect fraud, we will record this.
RSA may also search these agencies and databases to:
• Help make decisions about the provision and administration of insurance, credit and related services for you ;
• Trace debtors or beneficiaries, recover debt, prevent fraud and to manage your insurance policies with RSA;
• Check your identity to prevent money laundering, unless you furnish us with other satisfactory proof of identity;
• Undertake credit searches and additional fraud searches.
Insurance Link Database Information about claims (whether by our customers or third-parties) made under policies that we provide is collected by us when a claim is made and is placed on an insurance industry database of claims known as Insurance Link. This information may be shared with other insurance companies, self insurers or statutory authorities.
Insurance companies share claims data:
a. to ensure that more than one claim cannot be made for the same personal injury or property damage b. to check that claims information matches what was provided when insurance cover was taken out c. and, when required, to act as a basis for investigating claims when our recorded information is incorrect or when we suspect that insurance fraud is being attempted.
The purpose of Insurance Link is to help us identify incorrect information and fraudulent claims and, therefore, to protect customers.
Guidelines for sharing your information with other insurance companies, self-insuring organisations or statutory authorities are contained in the Data Protection Commissioner’s Code of Practice on Data Protection for the Insurance Sector which is available at www.dataprotection.ie Under the Data Protection Acts 1988 and 2003 you have a right to know what information about you and your previous claims is held on Insurance Link. If you wish to exercise this right then please contact us at the address below.
How to contact us On payment of a small fee you are entitled to receive a copy of the information we hold about you and to seek rectification of any inaccurate data. If you have any questions, or you would like to find out more about this notice you can write to the Data Protection Officer, RSA Insurance Ireland Ltd, Dundrum Town Centre, Sandyford Road, Dundrum, Dublin 16.
Consent By providing us with your information you consent to all of your information being used, processed, disclosed and retained as set out above.
CONTRACT LAWThe parties to a contract of insurance covering a risk situated in the Republic of Ireland are permitted to choose the law applicable to the contract. We propose that the contract will be governed by Irish Law. Communications between you and us about this policy will be in English. The insurer that you have entered into a contract with is RSA Insurance Ireland Limited.
CUSTOMER SERVICE AND COMPLAINTS PROCEDUREWe are anxious to provide the highest quality of customer service at all times. We are eager therefore to learn about any aspect of our service or products not meeting customer expectations.
If you have a complaint in connection with company service, the details of your policy, perceived conflict of interest or treatment of a claim please contact your Insurance Broker or our Customer Service Team at RSA.
Our Complaints Procedures ensure that we will respond to complaints within the timelines set out in the Consumer Protection Code. We will acknowledge each complaint in writing within 5 business days and will provide a point of contact for the handling of the complaint. We will endeavour to resolve complaints quickly but if this is not possible we will provide written updates at intervals of not greater than 20 business days. If the complaint is not resolved within 40 business days we will inform you of the anticipated timeframe for resolution and your right to refer the matter to the Financial Services Ombudsman’s Bureau. If your
complaint is not resolved to your satisfaction you may contact our:
Customer Complaints Manager, RSA Insurance Ireland Ltd, RSA House, Dundrum Town Centre, Sandyford Road, Dublin 16.
Tel: 1890 290 100, Outside Ireland Tel: + 353 1 290 1000.
In the event of the issue not being resolved you may contact:
The Insurance Information Service of the Irish Insurance Federation, 39 Molesworth St, Dublin 2. Tel: + 353 1 6761914 The service can advise you on how to continue further, and may be able to help sort the problem out. Contacting the Irish Insurance Federation will not affect your right to refer your complaint to the Financial Services Ombudsman’s Bureau.
You may be eligible to bring your complaint to the Financial Services Ombudsman’s Bureau. The details are below:
Financial Services Ombudsman's Bureau, 3rd Floor, Lincoln House, Lincoln Place, Dublin 2. Tel:1890 882090 or +353 1 You may only appeal a Financial Services Ombudsman’s Bureau finding to the High Court. We will not bear the cost of an appeal you bring.
It is declared, except where stated to the contrary below, that
The Property is:
• Maintained in a good state of repair
• Not left unoccupied for more than 45 consecutive days
• In an area free from flooding, subsidence, heave, landslip, coastal or river erosion
• Regularly occupied at night
• Occupied solely by me & my family as our principal residence, for residential purposes only and not used for business purposes
• Not used to store commercial goods or used as the place of employment for any employee of my company or firm.
The Caravan/Mobile Home is:
• Secured to the ground at its 4 corners
• Kept on a manned site or within 1/4 mile of the nearest occupied house
• Not heated by portable oil or gas heaters
• Not used as a permanent residence
• Not used for hire or reward I/We declare that all details, answers and information given in this proposal made by me/us are true to the best of my/our knowledge and belief.
I/We agree that this proposal and declaration shall be the basis of the contract between me/us and RSA.
BEFORE YOU PROCEED TO COVER, PLEASE ENSURE TO REVIEW ALL POLICY DOCUMENTATION IN ORDER TO
DECIDE IF THE PRODUCT IS RIGHT FOR YOU.NOTE THAT IN THE EVENT OF A CLAIM COVERED UNDER THE
POLICY, WE RESERVE THE RIGHT TO USE OUR MANAGED REPAIR NETWORK OF BUILDING CONTRACTORS TO
COMPLETE THE WORKS.