DHT Application



a) The undersigned does hereby warrant that the information provided above is complete and accurate to the best of my knowledge and belief. It is my understanding that underwriters shall rely upon the information and representations listed above in determining the terms, rates and conditions of coverage.
b) It is understood that any intentional misrepresentation or omission shall constitute ground for immediate cancellation of coverage and denial of claims, if any.
c) It is further understood that this application shall be attached to and form part of the policy should one be issued.
Person Completing This Application:
Applicant's Title: