If this insurance is taken out by a (commercial) partnership or a legal entity, the final questions also apply to: – the members of the partnership; – the (limited) partners of the commercial partnership; – the (managing) director(s) under the articles of association of the legal entity; – the shareholder(s) with an interest of 33.3% or higher and – insofar as these are a legal entity – their (managing) director(s) under the articles of association and shareholders with an interest of 33% or higher.

Declaration and signature Important! As an applicant/prospective policy holder you shall oblige to answer the questions on this application form to the best of your knowledge, you declare that you have taken note of the information and that you would like to obtain the insurance in accordance with this. The duty to supply information comprises everything that may be relevant for the assessment of the risk and person(s) applying. Questions to which you think De Goudse may already know the answer should also be fully answered. Facts and circumstances relevant to questions posed which arise after completion of this form but before De Goudse has made a final assessment regarding your application should also be disclosed. If there are other applicants apart from yourself that have reached the minimum age of 16 at the time of application then you should also disclose the same information as for yourself. If after the inception of the policy it later comes to light that one or more of the questions has not been truthfully or correctly answered, then this may lead to an adjusted or no compensation. If your intention was to deliberately mislead us in order to gain insurance coverage and our decision would have been not to insure you based on those actual facts then we reserve the right to terminate the insurance with immediate effect. By making this application you agree to the contents and administering of the policy conditions. These are available for perusal at our office and can be requested prior to applying for insurance coverage. They will in all cases be sent after acceptance together with the policy schedule. You agree to accept the insurance and pay the premium, assurance tax and costs.What do we use personal data for? When you apply for an insurance, we ask for personal data. We use your data to conclude and execute the agreement. We also use them to comply with legal obligations, to prevent and combat fraud, to make (statistical) analyzes and for marketing activities. Do we also provide the information to others? Sometimes we also provide (some of) your data to other parties, such as reinsurers, your advisor, postal companies, automation companies and companies to which we have outsourced specific tasks. We only do this if this is necessary and we take measures to ensure the security of your data. Furthermore, we do not provide your information to others, unless we are obliged to do so. This may include, for example, the tax authorities, supervisors, the police or the judiciary. How long do we keep your data? If you have provided data for a quotation, we will keep those six months. Your data that we need to conclude and carry out an insurance contract will be retained for a maximum of seven years after ending the contract. Code of Conduct We handle personal data carefully and in line with de Gedragscode Verwerking Persoonsgegevens Financiële Instellingen. You can find the consumer brochure of the Code of Conduct on www.goudse.nl if you enter ‘Privacy statement’ in the search window. De complete text can be read via the website of Verbond van Verzekeraars www.verzekeraars.nl. You can also request this from the Verbond van verzekeraars, PO Box 93450, 2509 AL The Hague, telephone: (070) 333 85 00. Your rights You have the right to view, modify or delete your personal data. You also have the right to object to the processing of these data, to limit their processing and to transfer your personal data to another organization. Do you want to use this right? Send a request to De Goudse for the attention of the Data Protection Officer, PO Box 9, 2800 MA Gouda or mail this to gegevensbescherming@goudse.com. Always send a copy of your identity card. Black out your photo and burgerservicenummer (BSN) in this copy to protect your privacy. The data protection officer responds as quickly as possible to your request, at least within four weeks. Do you think that we do not comply with privacy legislation properly? Then you can contact the Dutch Data Protection Authority autoriteitpersoonsgegevens. nl). Fraud Fraud is trying to obtain compensation or coverage under the insurance under false pretences, where there would in reality be no coverage.