Lloyd s Insurance. Effected through. This is to Certify that in accordance with the authorisation granted under the Contract (the

Transcription

1 Lloyd s Insurance Effected through This is to Certify that in accordance with the authorisation granted under the Contract (the number of which is specified in the Schedule) to the undersigned by certain Underwriters at Lloyd s, whose definitive numbers and the proportions underwritten by them, which will be supplied on application, can be ascertained by reference to the said Contract which bears the Seal of Lloyd s Policy Signing Office and in consideration of the payment of the premium specified herein, the said Underwriters are hereby bound, severally and not jointly, their Executors and Administrators, to insure in accordance with the terms and conditions contained herein or endorsed hereon. If the Assured shall make any claim knowing the same to be false or fraudulent, as regards amount or otherwise, this Certificate shall become void and all claim hereunder shall be forfeited. In Witness whereof this Certificate has been signed at the place stated and on the date specified in the Schedule by J(A) NMA2462 (3/1/95) Form approved by Lloyd s Market Association

2 TERMS AND CONDITIONS Section 1 The Cover Provided This Policy relies on information given on the Proposal Form completed by the Life Assured and to any examining medical practitioner. If any of the information provided to the Underwriter is not true or not complete and this might reasonably have affected their decision to provide this Policy, then they may: change the Terms and Conditions of this Policy amend the premiums payable under this Policy; or cancel this Policy and refund the premiums paid without interest. If the Underwriters cancel this Policy it will end and all benefits under it will cease. This Policy does not acquire a surrender value. The sum assured is only payable on death and there is no benefit payable at expiry of this Policy. The Underwriters, will pay the Sum Assured specified in the Schedule on production of proof satisfactory of: the death of the Life Assured during the Period of This Assurance and, the title of the person or persons claiming payment and, the age of the Life Assured (where such age has not been admitted), and subject to these Terms and Conditions and any amendments agreed in writing by Underwriters. Section 2 Premiums Premiums for your policy must be paid within 30 days of the Commencement Date of this Assurance and within 30 days of each due date thereafter. If a claim arises during this period, the unpaid premium will be deducted from any sum assured payable. The premiums payable are guaranteed not to change during the period of this Policy.

3 If your premium has not been paid by the end of these 30 days, this Policy will be cancelled and all benefits under it will cease. Section 3 Policy Exclusions This Policy does not cover death arising directly or indirectly arising out of, contributed to or caused by, or resulting from or in connection with an illness within the first 6 months of the Commencement Date of This Assurance. This means that during the first 6 months of your cover, the Underwriters will only pay a claim if the death is a direct result of an Accident resulting in a Bodily Injury. The definitions are as follows: Accident: A sudden, unexpected, unusual, specific event which occurs at an identifiable time and place. Accident shall also include: a. exposure resulting from a mishap to a conveyance in which the Assured Person is travelling; b. disappearance. Bodily Injury: Identifiable physical injury which is caused by Accidental, visible and / or violent means, and solely and independently of any other cause, except illness directly resulting from, or medical, or surgical treatment rendered necessary by such injury, occasions the death of the Assured Person. Section 4 Cancelling this Policy You have a statutory right to cancel this Policy within 30 days from the date of concluding this contract by completing and returning the Cancellation Form included with these documents. Providing the Cancellation Form is posted on or before the 30 th day after the commencement date of this Policy, we will repay any money you have paid to Clements Europe Ltd, free of any charges and within 30 days of receipt of the Cancellation Form. You may cancel this Policy at any time after the 30 th day after the commencement date of this policy by writing to Clements Europe Ltd (the contact details are shown in Section 9 of this Policy Certificate). No premiums will be refunded if this policy is cancelled after the 30 th day after the commencement date of this policy.

4 Section 5 Making a Claim If you need to make a claim, please contact Clements Europe Ltd (the contact details are shown in Section 9 of this Policy) and we will send you a Claim Form. In order to assess your claim, you will need you to complete and return the Claim Form together with the original Death Certificate. In addition, the Underwriters may need some, or, all of the following evidence depending on the nature and circumstances of the claim: Proof of the Life Assured s age Ownership details Medical reports and records Coroners and/or police reports Such other information as the Underwriters may reasonably require to assess the claim If it should be found that the age of the Life Assured was understated when this Policy commenced, then the sum assured shall be reduced to such a sum as would have been assured had the age been correctly stated. The Underwriters will not pay a claim if by doing so they will be in breach of any sanction, prohibition or restriction imposed by law or regulation. Section 6 Law This Policy shall be governed by and construed in accordance with the laws of England and Wales and each party agrees to submit to the exclusive jurisdiction of the courts of England and Wales. Section 7 Data Protection Clements Europe Ltd and the Underwriters each have a Confidentiality Policy in place in accordance with The Data Protection Act 1998 which means that your personal and medical information is held securely and access is limited to authorised individuals who need to see it. You are entitled to ask for a copy of your application form at any time. Section 8 Contracts (Rights of Third Parties) Act 1999 This Policy does not give any rights to any person other than the Policyholder and the Underwriters. No other person shall have any rights to rely on any terms under the Policy. Section 9 - How to contact us If you have any questions or concerns about this Policy or wish to make a claim, you, or your personal representative should contact Clements Europe Ltd. Their contact details are shown below:

5 By letter: Clements Europe Ltd 40 Lime Street, London, EC3M 7AW By By telephone: +44 (0) Section 10 Complaints Procedure Any complaint regarding the handling of this Policy or a claim should initially be addressed to Clements Europe Ltd (contact details are shown in Section 9 above): Clements Europe Ltd has internal complaints handling procedures, which are available on request. At any stage you can contact Lloyd s with your complaint. The contact details at Lloyd s are:- Policyholder & Market Assistance Market Services Lloyd s Fidentia House Walter Burke Way Chatham Maritime Kent ME4 4RN Telephone: +44(0) Fax: +44(0)

6 Details of Lloyd s complaints procedures are set out in a leaflet How We Can Help To Resolve Your Complaint available at and from the above address. If you are a resident of the United Kingdom and remain dissatisfied after Lloyd s has considered your complaint, you may have the right to refer your complaint to the Financial Ombudsman Service at the address below. If you are not a resident of the United Kingdom and remain dissatisfied after Lloyd s has considered your complaint, you may have the right to refer your complaint to your local Ombudsman or dispute resolution service. Alternatively you may be entitled to refer your complaint to the United Kingdom Financial Ombudsman Service at the following address. The Financial Ombudsman Service Exchange Tower Harbour Exchange Square London E14 9SR United Kingdom Telephone Number: (calls to this number are normally free for people ringing from a "fixed line" phone, but charges may apply if you call from a mobile phone). Telephone Number: (calls to this number are charged at the same rate as 01 or 02 numbers on mobile phone tariffs). complaint.info@financial-ombudsman.org.uk Further details will be provided at the appropriate stage of the complaints process. This complaint procedure is without prejudice to your right to take legal proceedings.

7 Section 11 Compensation Lloyd's insurers are covered by the Financial Services Compensation Scheme. You may be entitled to compensation from the Scheme if a Lloyd's insurer is unable to meet its obligations to you under this contract. If you were entitled to compensation under the Scheme, the level and extent of the compensation would depend on the nature of this contract. Further information about the Scheme is available from:- The Financial Services Compensation Scheme 10 th Floor Beaufort House 15 St Botolph Street London EC3A 7QU Website

8 POLICY SUMMARY The following summary does not contain the full Terms and Conditions of the contract which can be found in the Policy Certificate. This Policy Summary does not form part of your contract of insurance. About your policy: This insurance policy is underwritten by certain Underwriters at Lloyd's This insurance policy provides the following coverage: Term Life Assurance. The Life (Lives) Assured, or the Assured Persons: xxxxx The Policyholder: xxxxx The Sum Assured: xxxxx The Term: xxx Any other significant features: There is no cover for death due to an illness during the first 6 months of your policy The aim of this insurance policy is to pay out a guaranteed cash sum (the Sum Assured) if the Life Assured dies during the Term. Cancellation: You have a statutory right to cancel this Policy within 30 days from the date of concluding this contract by completing and returning the Cancellation Form included with these documents. Providing the Cancellation Form is posted on or before the 30 th day after the commencement date of this Policy, we will repay any money you have paid to Clements Europe Ltd, free of any charges and within 30 days of receipt of the Cancellation Form.

9 You may cancel this Policy at any time after the 30 th day after the commencement date of this Policy by writing to Clements Europe Ltd, New Broad Street House, 35 New Broad Street, London EC2M 1NH. No premiums will be refunded if this Policy is cancelled after the 30 th day after the commencement date of this Policy. Claims: (5) Your representative should notify Clements Europe Ltd, 40 Lime Street, London, EC3M 7AW Complaints: (6) Any complaint regarding the handling of this Policy or a claim should initially be addressed to Clements Europe Ltd, 40 Lime Street, London, EC3M 7AW Clements Europe Ltd has internal complaints handling procedures, which are available on request. At any stage you can contact Lloyd s with your complaint. The contact details at Lloyd s are:- Policyholder & Market Assistance Market Services Lloyd s Fidentia House Walter Burke Way Chatham Maritime Kent ME4 4RN Telephone: +44(0) Fax: +44(0) complaints@lloyds.com

10 Details of Lloyd s complaints procedures are set out in a leaflet How We Can Help To Resolve Your Complaint available at and from the above address. If you are a resident of the United Kingdom and remain dissatisfied after Lloyd s has considered your complaint, you may have the right to refer your complaint to the Financial Ombudsman Service at the address below. If you are not a resident of the United Kingdom and remain dissatisfied after Lloyd s has considered your complaint, you may have the right to refer your complaint to your local Ombudsman or dispute resolution service. Alternatively you may be entitled to refer your complaint to the United Kingdom Financial Ombudsman Service at the following address. The Financial Ombudsman Service Exchange Tower Harbour Exchange Square London E14 9SR United Kingdom Telephone Number: (calls to this number are normally free for people ringing from a "fixed line" phone, but charges may apply if you call from a mobile phone). Telephone Number: (calls to this number are charged at the same rate as 01 or 02 numbers on mobile phone tariffs). complaint.info@financial-ombudsman.org.uk Further details will be provided at the appropriate stage of the complaints process. This complaint procedure is without prejudice to your right to take legal proceedings. Compensation: (7) Lloyd's insurers are covered by the Financial Services Compensation Scheme. You may be entitled to compensation from the Scheme if a Lloyd's insurer is unable to meet its obligations to you under this contract. If you were entitled to compensation under the Scheme, the level and extent of the compensation would depend on the nature of this contract. Further information about the Scheme is available from:- The Financial Services Compensation Scheme

11 10 th Floor Beaufort House 15 St Botolph Street London EC3A 7QU Website

12 Your right to change your mind You have made an application for Term Life Assurance with Clements Europe Ltd and that application has been accepted. You have 30 days from the date of inception of the Policy in which to change your mind. Here are some questions and answers to help you decide. DO YOU UNDERSTAND WHAT YOUR POLICY WILL DO FOR YOU? Before you signed the proposal you should have been provided with a Key Features Document given details of how the Policy will provide life assurance protection. This should answer your questions. If there is anything which is still unclear, please contact us for help. IF YOU DECIDE TO PROCEED WITH YOUR POLICY WHAT SHOULD YOU DO? Ignore this notice and do nothing with the attached Cancellation Form. IF YOU WISH TO CANCEL, WHAT SHOULD YOU DO? Sign and date the attached Cancellation Form and send it, together with the Policy Certificate to Clements Europe Ltd, 40 Lime Street, London, EC3M 7AW. You must post it on or before the 30th day after the date of inception of this Policy. Providing the Cancellation Form is posted by you on or before the 30th day after the date of inception of this Policy, Clements Europe Ltd will repay you any money you have paid to them for this Policy, free of any charges, and within 30 days of receipt of the Cancellation Form.

13 WILL YOU LOSE ANYTHING BY CANCELLING THIS POLICY? Yes. You will lose the benefits which you identified were in accordance with your demands and needs when you decided to proceed with your application for Term Life Assurance. Complaints Procedure This is set out in the Policy Certificate.

14 CANCELLATION FORM IMPORTANT NOTICE ONLY RETURN THIS FORM IF YOU WISH TO CANCEL YOUR POLICY. To: Clements Europe Ltd 40 Lime Street, London, EC3M 7AW I hereby give notice that I have decided not to proceed with this Policy and I require the return of any money paid to you in connection with it, which I am entitled to have returned. I have attached my Policy Certificate. Signed: Life Assured Date : / /

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