The applicant(s) (collectively, the “Applicant”) confirms that he/she wishes to use InsureLine’s services and consents to InsureLine’s collection, use and disclosure of any personal information required for the following purposes:

• To determine eligibility and process applications for insurance products and to provide information and services as requested
• To understand and assess ongoing needs and offer products and services to meet those needs
• For communication, service, billing and administration purposes
• For claims administration and data analysis
• To comply with legal, audit, security and regulatory requirements
• To verify the personal information provided

The Applicant authorizes InsureLine to collect and/or disclose the Applicant’s personal information from/to third parties such as insurance companies, other brokers, adjusters, credit reporting agencies, motor vehicle/driver licensing authorities, financial institutions, medical professionals and others as may be required for the above purposes. If the Applicant is providing any additional insured personal information, the Applicant warrants having obtained the prior written consent from each additional insured for the collection, use and disclosure of their personal information as set out herein. The Applicant acknowledges that he/she may withdraw a previously given consent for one or more purposes at any time, by contacting InsureLine’ s Privacy Officer in writing and understands that such withdrawal may result in InsureLine’ s inability to provide the services requested. The Applicant acknowledges that this Consent remains in force until withdrawn by the Applicant in whole or in part, regardless of any other consents the Applicant may sign authorizing the collection, use or disclosure of personal information. InsureLine’ s Privacy Policy and Privacy Officer contact information is available by calling InsureLine’ s head office in Canada.