Assessment Declaration

I declare that the statements and particulars in the IASME / Cyber Essentials assessments are true and that no material facts have been misstated. A material fact is one which would influence the acceptance or assessment of the risk. I agree that this declaration together with any other information supplied shall form the basis of the Contract of Insurance (included in this assessment package) effected thereon. I undertake to inform the insurers of any material alteration to the facts [occurring before the completion of the contract of insurance]. A material fact is one which would influence the acceptance or assessment of the risk. I also declare to have read the applicable wording (1) and fully understood its scope, exclusions and limitations.

Company Name as registered with Companies House *

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Signatory Name (Board Level or Equivalent) *

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Job Title *

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Signature *

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Date *

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(1) Policy Document Wording

* Completion of all fields required before the insurance policy documents can be issued