| Thank You For Choosing Tawuniya We have received your medical malpratice insurance application and it is forwarded to the concerned underwriter for review and evaluation | A material fact is one which is likely to influence Tawuniya's acceptance or assessment of this proposal |
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| I hereby declare that I am the policy holder andI entered all fields by my self | Your Quotation code is : Back to Tawuniya Store |
To the best of my knowledge and belief, the above statements and particulars are complete and true and that I have not misstated or suppressed any material facts.
22| If in any doubt whether facts are material, they shouldbe disclosed | I declare that the documents submitted for identification are original and all particulars given are true and correct |
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| If any doubt whether facts are material, they should be disclosed | Tawuniya reserves the right to decline any application |
Submitting this form does not bind the applicant to complete the Insurance, nor Tawuniya to accept, but it is agreed that this form shall be the basis of the contract should a policy be issued.