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Data Protection Declaration

By checking the box below and typing my full name, I confirm/understand that:

  • In order to administer the policy and plan CG United Insurance Ltd. may process any and all of the personal data provided.
  • I consent to CG United Insurance Ltd. processing my personal data, in accordance with CG United Insurance Ltd.’s Privacy Policy. For additional information on your rights and how to exercise them, please access or request this Policy.
  • I confirm that any personal data I provide to CG United Insurance Ltd. in respect of any third party, is done with that third party’s consent and knowledge of CG United Insurance Ltd. processing of their personal data.
  • I have the right for my personal data to be processed in accordance with the rights of Data Subjects under the relevant jurisdictional privacy legislation.
  • I understand that this form shall be incorporated into and shall constitute a part of the policy contract between me/us and the Company.

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Data Protection Declaration

By checking the box below and typing my full name, I confirm/understand that:
  • In order to administer the policy and plan CG United Insurance Ltd. may process any and all of the personal data provided.
  • I consent to CG United Insurance Ltd. processing my personal data, in accordance with CG United Insurance Ltd.’s Privacy Policy. For additional information on your rights and how to exercise them, please access or request this Policy.
  • I confirm that any personal data I provide to CG United Insurance Ltd. in respect of any third party, is done with that third party’s consent and knowledge of CG United Insurance Ltd. processing of their personal data.
  • I have the right for my personal data to be processed in accordance with the rights of Data Subjects under the relevant jurisdictional privacy legislation.
  • I understand that this form shall be incorporated into and shall constitute a part of the policy contract between me/us and the Company.
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Coralisle Group Ltd.
Jardine House
33-35 Reid Street, Hamilton, Bermuda
Tel +1 441 296 3700 • Fax +1 441 295 1367 • www.cgcoralisle.com
Insurace Health Pensions Life
Your Message Subject or Title

Request for Update Information from:

 Update Information form

Customer Details

Title
First Name
Last Name
Middle Name
Date of Birth
Permanent Address
Mailing Address
Country of Birth
Country of Residence
National Reg. Number
Policy number or Vehicle Registration Number
Email Address
Work Phone Number
Mobile Phone Number
Home Phone Number

Data Protection Declaration

By checking the box below and typing my full name, I confirm/understand that:
  • In order to administer the policy and plan CG United Insurance Ltd. may process any and all of the personal data provided.
  • I consent to CG United Insurance Ltd. processing my personal data, in accordance with CG United Insurance Ltd.’s Privacy Policy. For additional information on your rights and how to exercise them, please access or request this Policy.
  • I confirm that any personal data I provide to CG United Insurance Ltd. in respect of any third party, is done with that third party’s consent and knowledge of CG United Insurance Ltd. processing of their personal data.
  • I have the right for my personal data to be processed in accordance with the rights of Data Subjects under the relevant jurisdictional privacy legislation.
  • I understand that this form shall be incorporated into and shall constitute a part of the policy contract between me/us and the Company.
Type your full name.
Home Contact us

Confidentila Notice:
This email and any attachments are confidential and may be legally privileged. If you are not the intended recipient be aware that any disclosure, distribution or use of this e-mail or any part thereof is prohibited and may be unlawful. If you have received this e-mail in error, please notify the sender immediately and delete this and any copy(ies) from your computer systems. Thank you for your cooperation.

Virus Warning:
Internet communications cannot be guaranteed to be secure, error-free, or virus-free. While reasonable precautions have been taken to minimize this risk, the sender does not accept liability for any damage sustained as a result of viruses and would advise the recipient to carry out their own virus check prior to opening any attached files.

Coralisle Group Ltd.
Jardine House
33-35 Reid Street, Hamilton, Bermuda
Tel +1 441 296 3700 • Fax +1 441 295 1367 • www.cgcoralisle.com
Insurace Health Pensions Life
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