Consent: I am applying for automobile insurance based on the information I have provided. I authorize the Insurer to collect, use and disclose (i) the information on this form; and (ii) additional information about my driving record, automobile insurance policy and claims history, and that of the listed drivers (from whom I declare I have obtained consent for these purposes), as required in connection with this application. I understand that this personal information is necessary to assess the risk, issue the insurance contract, renewal or change, detect and prevent fraud and investigate and settle any claims.