Disability Equipment Extended Warranty & Insurance Application Form

Transcription

1 Disability Equipment Extended Warranty & Insurance Application Form

2 Disability Equipment Extended Warranty & Insurance Application Form Fish Insurance is one of the UK's leading providers of insurance to people wishing to live an independent life, offering the highest level of cover and service to meet your specific needs. Extended Warranty Covers the cost of repairs, including call out, labour charges and parts fitted following sudden and unforeseen mechanical or electrical breakdown. Protection is available for both new and used disability products (less than 4 years old). Renewal will be offered (at our option) until your product is 5 years old. For products currently still within the manufacturer's warranty cover starts from the date the manufacturer's warranty expires. You may purchase up to an extra 4 years Extended Warranty. Where the manufacturer s warranty has expired, cover is only available on an annual basis and cover must be arranged within 30 days of the purchase date of your disability product. There is no cover for the first 90 days from inception date of the policy but thereafter renewal will be offered for a full 12 months. The product must be fully serviced and in good condition. Insurance Offers protection for both you and your disability product meeting the cost of repairs or a replacement product following accident or theft. Insurance cover commences upon acceptance. About Fish Insurance We were founded in 1975 with one aim to provide specialist insurance protection to people with disabilities. Today Fish Insurance protects over 80,000 people, their mobility aids and independent lifestyles through a portfolio that includes specially designed cover for disabled drivers, disabled travellers, mobility scooters, mobility aids, wheelchairs, adapted homes and people who use direct payment schemes to employ their own carers. All our specially trained claims, customer service and administration teams are based at our Preston headquarters and all our policies are also underwritten by leading insurers. We are authorised and regulated by the Financial Conduct Authority (reference ). Further Information A Policy Summary is detailed overleaf. Please check that the cover provided meets your requirements. If you require any of the terms or benefits explaining we would be delighted to assist you, just call our Customer Services Team on ^. Further details are also available at our website If you have not received your policy documents within 14 days, please contact Fish Insurance.

3 Disability Equipment Extended Warranty & Insurance Application Form How to proceed Call our Customer Services Team quoting Dealer Code: on ^. Please have your credit/debit card details to hand. Simply complete this application form in full, detach and post it to: Fish Insurance, 12 Sceptre Court, Sceptre Way, Bamber Bridge, Preston, PR5 6AW This form should be completed in full and in BLOCK CAPITALS. Your Details Title Forename(s) Surname Date of Birth: \ \ Address of person receiving support: Correspondence address if different: Postcode *Telephone: * *It is vital that you complete your contact details should we need to get in touch with you regarding your policy. Disability equipment Details Make Model Serial / Frame No. Year of Make Date of Purchase Value (if value exceeds 7000 please refer to Fish Insurance) Is your product still within the manufacturer s warranty? Yes No

4 Premiums Please select the period and cover you require (tick as appropriate). Extended Warranty 1yr Premiums/Period of cover 2yrs 3yrs 4yrs Used or Reconditioned Products (excludes first 90 days) 1yr Stairlift (Straight rail) Stairlift (Curved rail) Rise/Recline Chair, Bed Hoist, Bathlift Insurance Stairlift, Bed, Rise/Recline Chair Premiums/Period of cover 1yr 2yrs 3yrs 4yrs 5yrs Hoist, Bathlift Insurance Premium Tax is included at the current rate. For other equipment not listed above, please contact us for a quotation on ^. Cover Start Date Cover will NOT start until we accept your application. For immediate cover, payment can be made by calling ^. Payment Method Cheque/Postal Order (made payable to Fish Insurance) Visa / Mastercard / Switch /Visa Delta (please circle) Issue No (Switch Only) Card No. Valid From Expiry Date CVC The CVC (Credit Card Verification Code) is the last three-digit number on the back of your credit/debit card Cardholder s Name (as shown on card) Declaration Cardholder s Signature Enclosed are our term of business which form the basis of the insurance contract for this policy. For your own benefit and protection, you should read these carefully before signing this declaration. By signing this declaration, you are agreeing to abide by the terms and conditions of this policy, therefore if you do not understand any point, please contact Fish Insurance for information before signing. I understand that I have 14 days from the receipt of my policy documents in which to change my mind and to cancel the policy, after which the standard cancellation period detailed within your policy document will apply. Signature (Applicant or legal representative) Date

5 Disability Equipment Extended Warranty & Insurance Policy Summary Some important facts about your insurance are summarised below. This summary does not describe all the terms and conditions of your policy, so please take time to read the policy document to make sure you understand the cover it provides. Insurer: UK General Insurance Limited on behalf of Great Lakes Reinsurance (UK) SE. UK General Insurance Limited is a trading name of UK Underwriting Limited Disability Equipment Extended Warranty & Insurance These policies are designed to meet the demands and needs of a person wishing to purchase Extended Warranty and Insurance protection against unforeseen financial implications both now and in the future arising out of the ownership or usage of a disability product. Extended Warranty Significant features & benefits This section pays for repairs to the disability product including the cost of the parts fitted and labour costs involved following breakdown. Significant exclusions or limitations Restricted to Sudden and Unforeseen Electrical or Mechanical Breakdown Cost of repairing or replacing consumable items such as batteries, fuses, tyres and light bulbs The product must be serviced annually Where the Manufacturer s warranty has expired, there is no cover for the first 90 days from inception date of the policy Policy Section 14 Insurance Significant features & benefits Policy Cover applies in respect of Loss or damage Worldwide Cover (including Baggage Handler Cover) Significant exclusions or limitations Any User The use must be with your permission Theft by the User Loss or damage to tyres and/or accessories unless the insured item is damaged at the same time Maximum amount payable is 7000 unless otherwise stated on your policy schedule The Geographical Limits of the policy extend to worldwide in respect of Sections 1 & 2 only Excludes liability cover in North America & Canada Maximum period 21 days Maximum amount payable is the difference between the amount recovered from the baggage handlers and the cost of repair Policy Section ALL 1 13 Your cover is valid for the period of cover stated in your policy schedule. For policies of more than one year in duration, please review and update your cover periodically to ensure that it remains adequate. CANCELLATION RIGHT We hope you are happy with the cover this policy provides. However, you have the right to cancel it within 14 days of receiving the policy. Please refer to the Cancellation Section of the policy under General Conditions. MAKING A CLAIM If you have a claim, please telephone us on ^ as soon as possible to tell us about it. COMPENSATION SCHEME In the event that Great Lakes Reinsurance (UK) SE is unable to meet its liabilities you may be entitled to compensation from the Financial Services Compensation Scheme (FSCS). Further Information can be found in your policy under Compensation Scheme. COMPLAINTS PROCEDURE Please refer to our Terms of Business attached.

6 Terms of Business Introduction Throughout this Terms of Business document, references to we, us and our are references to Fish Insurance, a trading name of Fish Administration Limited. This section outlines important information of which you should be aware. If you are unsure about any aspect of our Terms of Business or have any questions regarding our relationship with you, please contact our Customer Services Team at 12 Sceptre Court, Sceptre Way, Bamber Bridge, Preston, PR5 6AW or by calling us on ^. All calls are recorded for training, monitoring and reviewing purposes. By asking us to quote for and arrange or handle your insurances, you are providing your informed agreement to these Terms of Business. For your own benefit and protection, you should read these terms carefully. If you are unsure about any aspect of our Terms of Business or have any questions regarding our relationship with you, please contact us at the above address. 1. Regulation We are authorised and regulated by the Financial Conduct Authority. Our Financial Services Register number is This can be checked on the Financial Services Register by visiting the FCA s website at or by contacting the FCA on Our Service We source and arrange products but do not offer advice or make recommendations when arranging your insurance. However, we may ask some questions to narrow down the selection of products on which we will provide details; you will then need to make your own choice about how to proceed. Our Mobility/Disability Equipment, Prosthetics, Independent Living (IL), Travel, Carer & Personal Assistant (CPA), Motor, UK Breakdown Recovery and Legal Expenses Insurance products are arranged from a single insurer. Our Home Insurance product is selected from a limited range of insurers. We offer additional products Excess Protection and Key Protection from one insurer for each product. Please refer to your Policy Summary or Application form for details of the insurer. All quotes offered will be valid for 30 days from the day you obtain the quotation. We will not in any circumstance guarantee the solvency of any insurer. 3. Complaints & Compensation If you are unhappy in any way with the service you have received from Fish Insurance, our complaints procedure enables you to express your dissatisfaction and have a full understanding of how your complaint will be handled. If unfortunately you feel our customer service levels have failed to meet your expectations, please contact us: By telephone: Claims related ^, other complaints ^. In writing addressed to: The Complaints Officer, at the above address. If you are not satisfied, you may be entitled to refer the matter to the Financial Ombudsman Service. A copy of the Complaints Procedure is available on request. You can contact the Financial Ombudsman Service by telephone on or visit their website We are covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if we cannot meet our obligations. This depends on the type of business and the circumstances of the claim. If you are eligible to claim from the FSCS, compensation is available as follows: Insurance advising and arranging is covered for 90% of the claim, without any upper limit For compulsory classes of insurance (such as Third Party Motor or Employers Liability), insurance advising and arranging is covered for 100% of the claim without any upper limit Further information about compensation scheme arrangements is available from the FSCS on , or 4. Handling Money We act as agents of the insurer in collecting premiums and handling refunds due to clients, such monies are deemed to be held by the insurers with which your insurance is arranged. 5. Claims Handling Arrangements You should take note of the required procedures in the event of a claim, which will be explained in the policy documentation. Generally, insurers require immediate notification of a claim or circumstances which might lead to a claim. We will employ due care and skill if we act on your behalf in respect of a claim. If we act on behalf of an insurer in negotiating and settling claims, we will inform you that we will be acting on behalf of the insurer, not yourselves, at the point of claim. 6. Conflicts of Interest Occasions can arise where we, or one of our associated companies, clients or product providers, may have a potential conflict of interest with business being transacted for you. If this happens, and we become aware that a potential conflict exists, we will write to you and obtain your consent before we carry out your instructions and we will detail the steps we will take to ensure fair treatment.

7 7. Cancellation of Insurance You should make any request for the cancellation of a policy by phone or post, and any relevant certificate of insurance (Motor & IL) must be returned to us or to the insurer concerned. Your Right to Cancel you have 14 days from receiving your documents to change your mind and receive a full refund of any premiums you have paid, provided you have not made any claims. No fees will be applied. Cancellation after Your Right to Cancel - No refund of premiums will be offered in the event of a cancellation for Mobility/Disability Equipment, Prosthetics, Travel, Excess Protection or Key Care Insurance policies after Your Right to Cancel period. For other policies, the terms of your policy may allow insurers to retain the premium in full or to charge pro rata premiums in the event of cancellation before the policy expires. In addition, a fee of 20 will be applied by us if you cancel an IL or CPA policy, 25 for a Home policy and 50 will be applied if you cancel a Motor policy. Your Motor insurance premium will include a payment for your UK Breakdown Recovery & Legal Protection cover of 55 which we have included as part of the Fish Motor Insurance Package. This payment is non-refundable upon cancellation of the policy after Your Right to Cancel period. 8. Fees In addition to premiums charged by your insurer, we will apply the following fees for arranging and administering your insurance product. These fees are non-refundable. New Business & Renewal (Motor) - 50 New Business & Renewal (Home) - 25 Mid-term Changes (Motor) - 30 Mid-term Changes (All other insurance products) - 20 Duplicate Documents and Payment Defaults (All insurance products) - 20 Minimum Refunds We will not refund where the amount is 10 or less. 9. Consumer Insurance (Disclosure & Representation) Act Please take reasonable care to answer all the questions honestly and to the best of your knowledge. If you don t answer the questions correctly, your policy may be cancelled, or your claim may be rejected or not fully paid. It is important that you read all insurance documents issued to you and ensure that you are aware of the cover, limits and other terms that apply. Particular attention must be paid to any warranties and conditions as failure to comply with them could invalidate your policy. 10. Use of personal data We will process any personal information we obtain in the course of providing our services to you in accordance with the Data Protection Act In administering your insurances it will be necessary for us to pass such information to insurers and other product or service providers which may also provide us with business and compliance support. We may also disclose details to relevant parties, as necessary, to comply with regulatory or legal requirements. We may contact you or pass your details to other companies associated with us in order to promote products or services which may be of interest to you. We will not otherwise use or disclose the personal information we hold without your consent. Some of the details you may be asked to give us, such as information about offences or medical conditions, are defined by the Act as sensitive personal data. By giving us such information, you signify your consent to its being processed by us in arranging and administering your insurances. Subject to certain exceptions, you will be entitled to have access to your personal and sensitive personal data for which you will be charged a fee of 10. If at any time you wish us, or any company associated with us, to cease processing any of the personal data or sensitive personal data we hold, or to cease contacting you about products and services, please write to us at the above address. 11. Failure to Pay a Premium Instalment If you choose to pay by direct debit, your monthly instalment plan will be financed by Premium Credit Limited. Premium Credit will send you a welcome pack which will include a credit agreement. In assessing your application Premium Credit will search the public information a credit reference agency holds about you. The credit reference agency will add details of the search to their records whether or not the application for credit proceeds. This and other information may be used to make credit decisions about you and to undertake checks for the prevention and detection of money laundering. Failing to make a payment when it is due may result in cancellation of the credit agreement and may result in cancellation of your insurance. Please note that in the event of payment default a fee will also be charged in accordance with the Fees section above. ^Calls to 0333 numbers are usually chargeable at a local rate from both UK landlines and mobile phones. These calls are usually included within network providers free minutes packages.

8 Fish Insurance, 12 Sceptre Court, Sceptre Way, Bamber Bridge, Preston, PR5 6AW T: ^ k