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Insurance Declaration Form Template for Ireland

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Key Requirements PROMPT example:

Insurance Declaration Form

"I need an Insurance Declaration Form for my tech startup's professional indemnity and cyber liability insurance, which needs to include specific declarations about our data handling practices and software development processes, to be effective from March 2025."

Document background
The Insurance Declaration Form is a fundamental document in the Irish insurance industry, required whenever an individual or organization seeks to obtain insurance coverage. This form, regulated under Irish law and particularly the Consumer Insurance Contracts Act 2019, serves as the primary tool for insurers to gather necessary information about the risk being insured. The document must be completed with utmost good faith, providing accurate and complete information about the subject matter of insurance, risk factors, and any material facts that could influence the insurer's decision to provide coverage. The form typically varies in content depending on the type of insurance being sought (e.g., property, liability, life, or health insurance) but maintains core elements required by Irish insurance regulations. It forms the basis for the insurance contract and can be referenced in case of future claims or disputes.
Suggested Sections

1. Personal Information: Essential details of the proposer including full name, address, date of birth, contact information, and any required identification numbers

2. Insurance Coverage Details: Specific information about the type of insurance being sought and the extent of coverage required

3. Risk Assessment Information: Details about the risk being insured, including relevant history and current circumstances

4. Previous Insurance History: Information about prior insurance coverage, claims history, and any insurance refusals or cancellations

5. Material Facts Declaration: Section for disclosing all material facts that could influence the insurance contract, as required by the Consumer Insurance Contracts Act 2019

6. Health and Safety Declaration: Statements regarding health and safety measures relevant to the insurance coverage

7. Data Protection Notice: GDPR-compliant information about how personal data will be collected, used, and protected

8. Declaration and Signature: Final declarations of truth and accuracy, with signature block and date

Optional Sections

1. Medical History: Required for health or life insurance applications, including detailed medical questions and history

2. Property Details: Required for property insurance, including building specifications and security measures

3. Vehicle Information: Required for motor insurance, including vehicle details and driver information

4. Business Operations: Required for commercial insurance, including business activities and risk management procedures

5. Additional Insured Parties: Optional section for listing additional people to be covered under the policy

6. International Coverage: Required when insurance coverage extends beyond Ireland

Suggested Schedules

1. Schedule A - Risk Details: Detailed breakdown of specific risks to be covered and any exclusions

2. Schedule B - Property Schedule: Detailed list of properties or items to be insured with their values and specifications

3. Schedule C - Claims History: Detailed information about previous claims and their outcomes

4. Appendix 1 - Supporting Documentation Checklist: List of required supporting documents to be submitted with the declaration form

5. Appendix 2 - Premium Calculation: Breakdown of premium calculations and payment options

6. Appendix 3 - Terms and Conditions: Detailed terms and conditions applicable to the insurance coverage

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈ˰æ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions








































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Relevant Industries

Financial Services

Insurance

Banking

Real Estate

Healthcare

Manufacturing

Retail

Construction

Transportation

Agriculture

Professional Services

Technology

Education

Hospitality

Non-profit Organizations

Relevant Teams

Legal

Compliance

Risk Management

Underwriting

Claims Processing

Customer Service

Sales

Operations

Document Management

Regulatory Affairs

Product Development

Client Relations

Relevant Roles

Insurance Underwriter

Risk Manager

Compliance Officer

Insurance Broker

Claims Manager

Legal Counsel

Insurance Agent

Policy Administrator

Risk Assessment Officer

Insurance Operations Manager

Actuarial Analyst

Customer Service Representative

Insurance Sales Executive

Documentation Specialist

Regulatory Affairs Manager

Industries








Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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