Dentists Indemnity Indication Form

Data Protection Act – All personal information supplied by you will be treated in confidence by Dental Insurance Agency and will not be disclosed to any third parties except where your consent has been received or where permitted by law. In order to provide you with products and services this information will be held in the data systems of Dental Insurance Agency or our agents or subcontractors. By providing this information you are consenting to us contacting you solely in relation to products we offer and arranging insurance on your behalf. Any 'material fact' must be disclosed to Insurers. A 'material fact' is any information which may alter the judgement of an Insurer in assessing the risk. Any 'material change' must be disclosed to Insurers. A 'material change' is any information which may alter the judgement of an Insurer that has not previously been disclosed as a material fact. Failure to provide all 'material facts' and/or notify all 'material changes' may cause the contract of insurance to be void and may result in Insurers repudiating liability entirely. If you have any questions when completing this form please contact us on 0345 034 1432.