I have read and understood the Insurance Product Information Document and the Terms of Business Agreement. I agree to my information being passed to Mark Bates Ltd for the provision of insurance and to the Insurer for the purpose of accepting insurance and handling any claims, where if necessary, it may be divulged to third parties, provided my information will be processed in compliance with the provisions of the General Data Protection Regulation. You have not had an incident involving mobility equipment within the last 3 years that would of resulted in a claim for the insurance described in the Insurance Product Information document.