Intermediary Declaration

Before we can accept this online application, you must confirm that your client has read and agreed to the use of their personal information and that they agree with all the statements in the "declaration and consent" sections contained in the following link:


The following statements contain important information. We will ask you to confirm you have read and accept them below:

By continuing this application, I confirm that:

I am aware of the importance of reading the Key Facts Document and Plan Conditions and that these documents, together with the Policy Schedule, Payment Schedule, this Declaration and any information given in this application process, will apply to my policy;

I am aware that if any of the information I have provided to Reviti Limited is not truthful, accurate or complete then the policy may be amended or cancelled, or claims may be refused. I am aware that I need, and I have obtained the consent of, any other person to be insured under the policy if I have answered questions on their behalf;

I, and any other person to be insured, are permanently resident in the UK (this excludes the Channel Islands and the Isle of Man).

Use of your data

Data will be used for the purpose of processing your application and administering your policy, claims handling, detection and prevention of fraudulent claims, and research and analysis to help us improve our products and services.

Please read our Privacy Policy available at which provides full information about how data (including any sensitive data) about you and anyone named on your policy will be used, who it will be shared with and information about your rights in relation to this data.