Insurance Declaration Form Template for Nigeria

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Key Requirements PROMPT example:

Insurance Declaration Form

"I need an Insurance Declaration Form for my manufacturing company's property and machinery insurance coverage starting March 1, 2025, that includes specific declarations about our industrial equipment worth ₦100 million and our safety protocols."

Document background
The Insurance Declaration Form is a fundamental document in Nigerian insurance practice, required under the Insurance Act 2003 and regulated by the National Insurance Commission (NAICOM). This document is essential when applying for new insurance coverage or renewing existing policies across various insurance types, including life, health, property, and general insurance. The form serves multiple purposes: it captures all material information needed for risk assessment, establishes the basis for the insurance contract, ensures regulatory compliance, and protects both the insurer and insured by creating a clear record of disclosures. The Insurance Declaration Form must be completed with utmost good faith, as any misrepresentation or omission can void the insurance contract and lead to legal consequences under Nigerian law.
Suggested Sections

1. Personal Information: Declarant's full details including name, address, contact information, and identification details as required by Nigerian law

2. Risk Details: Specific information about the subject matter to be insured, including all relevant details for risk assessment

3. Previous Insurance History: Details of any previous insurance policies, claims history, and relationships with other insurers

4. Material Facts Declaration: Mandatory disclosure of all material facts that could influence the insurer's decision to provide coverage

5. Health and Lifestyle Declaration: For personal insurance, details about health conditions, lifestyle factors, and medical history

6. Financial Information: Required financial disclosures for insurance coverage assessment and anti-money laundering compliance

7. Beneficiary Information: Where applicable, details of nominated beneficiaries and their relationship to the declarant

8. Declaration and Signature: Final declaration of truth and accuracy, with legal warnings about false declarations and signature section

Optional Sections

1. Business Operations: For commercial insurance, details about business activities, operations, and risk management procedures

2. Property Details: For property insurance, specific section detailing property characteristics, security measures, and value

3. Vehicle Information: For motor insurance, specific details about vehicles, usage, and drivers

4. Maritime Declaration: For marine insurance, specific details about vessels, cargo, and maritime operations

5. Group Insurance Details: For group policies, information about all members to be covered under the policy

6. International Coverage: For policies with international scope, details about foreign operations and jurisdictions

Suggested Schedules

1. Schedule A - Premium Payment Details: Payment schedule, methods, and terms for premium payments

2. Schedule B - Coverage Limits and Deductibles: Detailed breakdown of coverage limits, sub-limits, and applicable deductibles

3. Schedule C - Risk Exclusions: Comprehensive list of standard and specific exclusions applicable to the policy

4. Appendix 1 - Required Documentation Checklist: List of supporting documents required for the insurance application

5. Appendix 2 - Terms and Conditions: Standard terms and conditions applicable to the insurance policy

6. Appendix 3 - Privacy Notice: Information about how personal data will be collected, used, and protected as per Nigerian regulations

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions
Clauses
Relevant Industries

Insurance

Financial Services

Healthcare

Real Estate

Manufacturing

Transportation

Maritime

Aviation

Agriculture

Energy

Construction

Retail

Professional Services

Relevant Teams

Legal

Compliance

Risk Management

Underwriting

Sales

Customer Service

Operations

Claims Processing

Policy Administration

Document Management

Business Development

Relevant Roles

Insurance Underwriter

Risk Manager

Compliance Officer

Insurance Agent

Insurance Broker

Claims Manager

Legal Counsel

Policy Administrator

Business Development Manager

Customer Service Representative

Operations Manager

Chief Risk Officer

Insurance Sales Executive

Documentation Specialist

Industries
Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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