I, on behalf of each of myself and all insured drivers:, hereby declare as follows:

• 1. Reside in Hong Kong
• 2. Are aged between 25 and 70 years
• 3. Has at least 2 years driving experience
• 4. Does not engage in the following occupations: automobile, catering, courier service, detective, debt collection service, driver, entertainment, fashion, fitness and sports training, food, gambling, hawker, jockey, logistics, media, night clubs, political, professional sportsman, security, student, transportation, editor, journalist and unemployed.
• 5. Do not have any motor policy being terminated or refused for quotation by another insurance company in the past

In the past 3 years, myself and all insured drivers:

• 1. Has not made a motor insurance claim
• 2. Has not accumulated more than 12 driving-offence points
• 3. Has not been disqualified from driving

The motor vehicle:

• 1. Has not been modified from manufacture's standard specifications
• 2. Is not used for tuition purpose, rental, leasing, hire or reward (including but not limited to UBER or GOGOVAN or LALAMOVE or any car-sharing or any ride-sharing activities), rallies, competitions, speed testing, trials, motor sport or as courtesy car

General

• 1. We understand that the policy is only effective after my/our enrolment has been accepted by Allianz Global Corporate & Specialty SE (incorporated in the Federal Republic of Germany with limited liabilities) Hong Kong Branch (“we”, “us” “Allianz” or “the Company”)
• 2. In respect of specific products or services, such as when providing insurance, we may collect sensitive Personal Data about your health and medical history depending on the type of service provided
• 3. I acknowledge and understand that laws and regulations of some jurisdictions outside Hong Kong may impose certain restrictions and/or requirements when their residents or citizens purchase insurance policies issued by foreign insurance companies and to the best of my knowledge I shall inform Allianz if the law of my country has any restrictions and/or requirements and/or prohibitions. I shall also, to the best of my ability, abide by any such laws or regulations that might be imposed on me from time to time and be fully responsible for any failure to abide by such laws or regulations
• 4. I have read, understood and accepted the terms, conditions and exclusions contained in the Policy Wordings and any information or material relating to this Policy
• 5. In the event of any discrepancy between the English or Chinese versions of any content related to this policy, the English version shall prevail

Accuracy of Information

• 1. All information given in the application form for this policy are true and complete to the best of my knowledge and I have not withheld any material facts which are relevant to or could affect the acceptance of this application by Allianz. I understand that any inaccuracy or non-disclosure may render the policy voidable
• 2. In the event that there is any change in material facts that occurs after the submission of this application but before policy issuance, I shall disclose any such information to Allianz as soon as reasonably possible
• 3. I agree that this application and declaration and other information provided shall form the basis of the policy

Other

• 1. We understand that Allianz may use my email to contact me/us about my application. By submitting this online application, I/We are consenting to this form of communication between me/ us and Allianz

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