Name

Surname

Mobile number

email

ID/Passport number

Upload copy of ID (front)

Upload copy of ID (back)

Are you an existing GO customer

Account number

GO Insure form

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<p> </p>
<p style="text-align: center;">Protect the contents of your home against theft, fire, storm, burst pipes and other causes <strong>hassle-free for just €7.50/month</strong> and a <strong>one-time yearly duty fee of €13</strong>.</p>


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<h1 style="text-align: center;"><strong>GO Insure – Proposal Form</strong></h1>


Postal address

Address of property to be insured

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<p> </p>
<p style="text-align: center;">Enter your postal address where we can reach you by post, along with the complete address of the property you wish to insure.</p>


<h1 style="text-align: center;"><strong>Address information</strong></h1>


Claims & losses confirmation

No existing policy

Insurance documents review

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<p> </p>
<p style="text-align: center;">Before we can issue your policy, we need your confirmation on a few key points. Please review and agree to the following statements. Take a look at the <a href="https://prodcms.go.com.mt/wp-content/uploads/2025/10/IPID.pdf" target="_blank" rel="noopener">IPID</a>, <a href="https://prodcms.go.com.mt/wp-content/uploads/2025/10/Policy-Wording.pdf" target="_blank" rel="noopener">Policy Wording</a> and <a href="https://prodcms.go.com.mt/wp-content/uploads/2025/10/Payment-Terms-Conditions.pdf" target="_blank" rel="noopener">Payment Terms & Conditions</a>.</p>


<h1 style="text-align: center;"><strong>Acknowledgements & Confirmations</strong></h1>


Confirmation of Disclosure

<p>My Private Residence</p>
<ul>
<li>is not being rented out or used for the carrying out of any business other than office type work;</li>
<li>is of standard construction used in Maltese properties;</li>
<li>is in an area normally free from flooding;</li>
<li>is surrounded by occupied private residences;</li>
<li>is complete in every respect including any building works or internal alterations;</li>
<li>is protected by doors and windows against wind, rain and other elements;</li>
<li>is in a good state of repair;</li>
<li>is not unoccupied for more than 90 consecutive days;</li>
<li>is not adjacent to any ongoing construction works;</li>
<li>is not used to store, manufacture or transport any high explosives including pyrotechnic; materials (fireworks) in or about the property;</li>
</ul>
<p>I, including family members residing with me,</p>
<ul>
<li>have never been arrested;</li>
<li>do not have any pending prosecutions;</li>
<li>have never been convicted of any offence (other than driving offences); and</li>
<li>have never been declared bankrupt.</li>
</ul>


<h1 style="text-align: center;"><strong>Statement of Fact – Disclosures</strong></h1>


Confirmation of Declaration

<ul>
<li>I have read this proposal/statement of fact including the declaration and any other documents supplied;</li>
<li>I agree that the Policy, Policy Schedule and Statement of Fact will be the basis of the contract between me/us and Atlas Insurance PCC Ltd;</li>
<li>I understand that all relevant information, which is information that may influence Atlas Insurance PCC Ltd in the acceptance of this insurance and the terms provided, has been disclosed and recorded;</li>
<li>I declare that all particulars given on the Statement of Fact, whether made by me/us or on my/our behalf, are true and complete;</li>
<li>I understand that if full and true answers have not been given or if all relevant information has not been disclosed, this insurance may not protect me/us in the event of a claim;</li>
<li>I will advise Atlas Insurance PCC Ltd of any change to the details given before the start date of the contract;</li>
<li>I have read, understood and agree to the terms of the Atlas Data Protection and Privacy Policy https://www.atlas.com.mt/legal/data-protection/</li>
</ul>


<h1 style="text-align: center;"><strong>Declaration </strong></h1>


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<p> </p>
<p style="text-align: center;">Our insurance team is now processing your application. If this is accepted, you will receive your policy documents by email at the address you have provided for your review and signature within 1-2 working days.</p>


<h1 style="text-align: center;"><strong>Thank you for your interest in GO Insure Home Contents</strong></h1>
