Bollington Courier Motor Insurance Statement of Fact

Transcription

1 Bollington Courier Motor Insurance Statement of Fact Please read the following information carefully. It is a record of the latest information you have provided to us. If you disagree with any of the statements then you must contact your insurance intermediary immediately. Proposer Full Name of the Proposer Company Or Trading Name Mr Glen Campbell Mr Glen Campbell Operating address 10 Bingham Road Rochester ME2 4JL Date of Birth 19/09/1976 Telephone Number Occupation Business/ Employers Business Courier Courier Services Period of Insurance This statement of fact, your policy schedule, your policy wording and any endorsements form a contract of insurance between you (the insured named on the schedule) and us From: 29/12/ :48 to: 22/12/ :59 Vehicle to be Insured Registration EX05XOS GVW 1805 Kg Make & Model VAUXHALL COMBO CDTI Seats 3 Body Type Van Purchase Date 29/12/2015 Year of Manufacture 2005 Market Value 1500 Overnight Parking Anticipated Annual Mileage Geographical Limits Has your vehicle been modified from the manufacturer s original specification? Give full details of any approved security devices, other than those fitted as standard by the manufacturer Who is the owner of the vehicle? Who is the registered keeper of the vehicle? Parked On Drive 25,000 Miles Great Britain Only Modification Type Modification Value Modification Date Additional Information ne Proposer/Policyholder Proposer/Policyholder Cover & Claims Discount Cover required Third Party, Fire And Theft Number of years Claim Discount Entitlement 4 Years Claim Discount Type Commercial Vehicle Do you want to protect your Claim Discount? When did the policy expire? 29/12/2015 Acceptable evidence of your entitlement must be submitted within 14 days of the commencement date shown above Use Give details of the purposes for which the vehicle will be used Carriage Of Goods For Hire And Reward Enterprise Insurance Company Plc. Registered in Gibraltar with a registered office at Suite 3, 2nd Floor, Icom House, 1-5 Irish Town, Gibraltar, GX11 1AA. Enterprise Insurance Company Plc. is licensed by the Financial Services Commission in Gibraltar under the Financial Services (Insurance Companies) Act to carry on insurance business in Gibraltar, and is authorised to operate in the UK by the Financial Conduct Authority Registration /12/ :12:02 Campbell Page 1 of 4

2 Drivers Driving Restriction Proposer Only Give full details of you and all other persons who may drive the vehicle Full Name Glen Campbell Date of Birth 19/09/1976 Occupation Courier Business/Employers business Courier Services Type of Driving licence Held Full UK Car Licence Driving Licence Number Resident in the UK 39 years Relationship to proposer Proposer Has proposer, spouse/common law spouse/civil partner or any other name driver: DISABILITIES, CONVICTIONS AND CLAIMS HISTORY Ever been diagnosed with diabetes, defective sight/hearing, lost a limb, lost an eye or suffers from any physical or mental infirmity? Have the conditions mentioned above been advised to the DVLA? If the condition has been notified to the DVLA, have they issued the driver with a licence? You are reminded that all drivers are required by law to inform the Drivers Medical Branch at DVLA if they have any disability (including any physical conditions) which affects or may become likely to affect their fitness as a driver Have you or any person who will drive the vehicle ever been convicted ( or have prosecution pending) for any non motoring offences other than as spent under the Rehabilitation of Offenders Act 1974? Have you or any person who will drive the vehicle ever been convicted of any offence (including fixed penalties) in connection with the following; a motor vehicle or police enquiry in the past 5 years, any offence related to alcohol/drugs in the past 10 years, any prosecutions pending, convictions, offences, traffic violations, fraud, theft, malicious acts of violence? Motoring Convictions in the last 5 years including fixed penalty notices: N/A N/A Driver Name Motoring Offence Code Date Fine. Points Ban. Months Glen Campbell CU80 21/03/ MS90 19/05/ Has the proposer or any driver ever had any insurance cancelled (including cancellation following default payment of an insurance premium) refused or had any special terms imposed in the last 3 years? Have you or any person who will drive the vehicle had any accident, claim, incident, theft or loss involving a motor vehicle (whether to blame or not) during the past 3 years? Accidents, incidents, losses and claims in the last 3 years: Driver Name Date of Incident Incident Type Costs ( ) Costs Recovered? Have you, or has any driver who to your knowledge will drive i.e. proposer,, spouse/ common law spouse/civil partner of any named driver: Had any insurance cancelled by an insurer? Been refused insurance or had renewal refused? Had special terms imposed by an insurer? Excess Voluntary excess selected 0 This amount will be in addition to any standard excesses that may apply (please refer to the policy wording) Goods In Transit Full Responsibility Sum Insured 10,000 Excess 250 Misfueling Cover Limit of Liability Excess 50 You will pay the first 50 for approved costs properly incurred solely and directly arising from misfuelling of the insured vehicle. The policy covers you up to a maximum limit of liability of 500 Enterprise Insurance Company Plc. Registered in Gibraltar with a registered office at Suite 3, 2nd Floor, Icom House, 1-5 Irish Town, Gibraltar, GX11 1AA. Enterprise Insurance Company Plc. is licensed by the Financial Services Commission in Gibraltar under the Financial Services (Insurance Companies) Act to carry on insurance business in Gibraltar, and is authorised to operate in the UK by the Financial Conduct Authority Registration /12/ :12:02 Campbell Page 2 of 4

3 Important tes Your cover starts from the date you are issued with a cover note or Certificate of Motor Insurance and no earlier than the start date shown on that document. The Insurers reserve the right to decline any insurance risk or change the premium and the terms quoted. Governing Law Unless another law is agreed in writing, this policy is governed by English Law. If there is a dispute, it will only be dealt with in the courts of England or of the country within the United Kingdom in which your main residence is situated. Data Protection We are governed by the Data Protection legislation applicable in both the United Kingdom and Gibraltar. Under this legislation we are required to tell you about how we will use the information that you give your Insurance Intermediary, who we may share information with and the systems we have in place that allow us to detect and prevent fraudulent applications for insurance and claims. The savings that we make help us to keep our premiums and products competitive. Sensitive Data In order to assess the terms of your insurance or to administer claims we may need to collect data that Data Protection legislation defines as sensitive (such as medical conditions and criminal convictions). In taking out insurance with us you are giving us your consent to such information being processed by us, and other companies contracted by us to provide services relating to your insurance or to a claim. In giving us and your insurance intermediary information about another person, you confirm that they have given you permission to give the information to us and your insurance intermediary and that we/they may process it (including any sensitive data see below) for the purposes as set out in these notices. On payment of 10 you are entitled to receive a copy of the information we hold about you. If you have any questions, or you would like to find out more about this you can write to the Compliance Enterprise Insurance Company PLC R22 - R24 Ragged Staff Wharf Queensway Quay Gibraltar GX11 1AA Motor Insurance Database The policy details will be added to the Motor Insurance Database (MID) run by the Motor Insurers Information Centre (MIIC). MID data may be used by the DVLA and DVLNI for the purpose of Electronic Vehicle Licensing and by the Police for the purposes of establishing whether a driver s use of the insured vehicle is likely to be covered by a motor insurance policy and/or for preventing and detecting crime. If you are involved in an accident in the UK or abroad other UK insurers, the Motor Insurers Bureau and MIIC may search the MID to obtain relevant document information. Persons pursuing a claim in respect of a road traffic accident (including citizens of other countries) may also obtain relevant information which is held on the MID. You can find out more about this from: Anti-Fraud and Theft Registers Your details may be passed on to the Claims and Underwriting Exchange Register (CUE) run by Insurance Database Services Ltd (IDSL) and the Motor Insurance Anti Fraud and Theft Register (MIAFTR) run by the Association of British Insurers (ABI). We also exchange information with the police and/or other insurers and other organisations through various databases. The aim is to help us check information provided and also to prevent fraudulent claims. Under the conditions of the policy you must tell us about any incident such as an accident or theft which may or may not give rise to a claim. We will pass information relating to this incident to the registers. Fraud If your claim is found to be in any respect fraudulent or if any fraudulent means or devices be used by you or anyone acting on their behalf to obtain any benefit under this policy or if any liability, loss, destruction or damage be occasioned by wilful act or with the connivance of the insured all benefits under this policy shall be forfeited and we shall not be liable to pay any outstanding or future claims. Further, any claim paid to the insured in respect of any fraudulent means or device must be repaid to the insurer. DVLA MyLicence The MyLicence programme will give insurers access to accurate data from the Driver and Vehicle Licensing Agency ( DVLA ) on motoring entitlements, convictions, and penalty points when providing quotes for insurance policies. 1. Insurance underwriting purposes MyLicence is used for: Insurance underwriting purposes i.e to examine the potential risk in relation to your (and/or a third party s) prospective policy so that we can: provide your (or any person included on the proposal form or statement of fact) Driving Licence Number ( DLN ) to the DVLA to confirm your (or the relevant person included on the proposal form or statement of fact) licence status, entitlement and relevant restriction information and endorsement/conviction data. Searches may be carried out prior to the date of the insurance policy and at any point throughout the duration of your insurance policy including at the mid-term adjustment and renewal stage. A search of the DLN with DVLA should not show a footprint against your (or another relevant person included on the proposal form or statement of fact) driving licence. search your (or any person included on the proposal form or statement of fact) Claim Discount details against a Claim Discount database ( NCD ) to obtain information in relation to your Claim Discount entitlement. Such searches may be carried out against your (or the relevant person included on the proposal form or statement of fact) DLN, name, date of birth, Vehicle Registration Mark VRM and or postcode. A search of the DLN against the NCD should not show a footprint against your (or another relevant person included on the proposal form or statement of fact) driving licence. searches may be carried out at a point of quote and if an insurance policy is incepted at the renewal stage. These checks may be made when you take out insurance with us or if you make a claim and the information shared with anyone acting on our behalf to administer your insurance or a claim (e.g. loss adjusters or investigators) You are required to take care to supply accurate and complete answers to all the questions you were asked at the time of insuring with us. It is important that you check your records for the information you have provided and notify us immediately of any changes to these details. Failure to provide accurate and complete information to the best of your knowledge may result in increased premiums, refusal of a claim or your policy being cancelled. You are required to update us with any changes to the information you provided at the time you asked us to insure you. The changes include the following and if you do not tell us about these changes, this may result in increased premiums, refusal of a claim or your policy being cancelled. 2. Anti-fraud purposes Anti-fraud purposes i.e. to detect and prevent fraudulent claims and/or activities by: undertaking searches against your (or any person included on the proposal form or statement of fact) DLN against details held by the DVLA to confirm your licence status, entitlement and restriction information and endorsement/conviction data. This helps insurers check information to prevent fraud and reduce incidences of negligent misinterpretation and non-disclosure. A search of the DLN with the DVLA should not show a footprint against your (or another relevant person included on the proposal form or statement of fact) driving licence. search your (or any person included on the proposal form or statement of fact) Claim Discount details against a Claim Discount database ( NCD ) to obtain information in relation to your Claim Discount entitlement. Such searches may be carried out against your (or the relevant person included on the proposal form or statement of fact) DLN, name, date of birth, Vehicle Registration Mark ( VRM ) and or postcode. A search of the DLN against the NCD should not show a footprint against your (or another relevant person included on the proposal form or statement of fact) driving licence. Your personal data will not be used for marketing. It will only be shared within organisations involved with the administration of your insurance policy or as otherwise set out in this Data Protection tice. We will pass details of your Claim Discount to certain organisations to be recorded on a NCD database. This will occur if information requires updating or correcting at any stage, and also at the renewal stage of your policy and upon or after the cancellation of your policy prior to the expiry date. For details relating to information held about you by the Driver and Vehicle Licensing Agency ( DVLA ) please visit What to do if you have a complaint We and your insurance intermediary aim to provide you with a prompt and efficient service at all times but on occasions this may not be possible and we/they may fall short of your expectations. If we or your insurance intermediary have not provided you with a prompt and efficient service and you wish to complain, please contact your insurance intermediary as shown on your policy schedule. If your complaint is in relation to the way in which your insurance was sold, relates to the service provided by your intermediary, or to a claim, your insurance intermediary will deal with your complaint. If your complaint is about our service or the policy terms and conditions, your insurance intermediary may refer your complaint to us. We or your insurance intermediary will investigate your complaint and issue a final response letter. If you are unhappy with the final response and you are an eligible complainant (an individual consumer or a micro-enterprise or a charity or trustee of a trust under a certain size) you may wish to contact the Financial Ombudsman Service. They offer a free and independent service for resolving disputes about most financial matters and you have six months from the date of the final response letter to contact them. Please note that the Financial Ombudsman Service will not adjudicate your complaint until you have received a final response letter or eight weeks has passed since you notified us/your insurance intermediary of your complaint. Their contact details are: Financial Ombudsman Service South Quay Plaza 183 Marsh Wall London E14 9SR Website: complaint.info@financial-ombudsman.org.uk Phone: or The Financial Ombudsman Service decision is binding on us but not you. The complaints procedure set out above does not affect your right to take legal action against us or your insurance intermediary. Enterprise Insurance Company Plc. Registered in Gibraltar with a registered office at Suite 3, 2nd Floor, Icom House, 1-5 Irish Town, Gibraltar, GX11 1AA. Enterprise Insurance Company Plc. is licensed by the Financial Services Commission in Gibraltar under the Financial Services (Insurance Companies) Act to carry on insurance business in Gibraltar, and is authorised to operate in the UK by the Financial Conduct Authority Registration /12/ :12:02 Campbell Page 3 of 4

4 Declaration Once you have read and understood the Important tes in Section 8 above, please read the declaration below. Provided you are satisfied the information in this statement is accurate, and that you are able to comply with the declaration below, you should retain this document for your own records. If, however, any information is incorrect or requires alteration, you must contact us immediately I/we declare that to the best of my/our knowledge and belief that all information given on this statement is true and complete. I/we acknowledge that Enterprise Insurance Company plc (the "Insurers") will rely on the information contained in this statement, before deciding whether to accept my/our risk and in fixing the insurance premium. I/we declare that to the best of my/our knowledge and belief, the details of the motor vehicle(s) are correct and that it/they is/are in a roadworthy condition. I/we declare that no material information has been intentionally withheld, concealed or misrepresented by me/us that might influence the Insurer's acceptance and assessment of my/our application. I/we understand that non-disclosure or misrepresentation of any material fact may render the policy void. Enterprise Insurance Company Plc. Registered in Gibraltar with a registered office at Suite 3, 2nd Floor, Icom House, 1-5 Irish Town, Gibraltar, GX11 1AA. Enterprise Insurance Company Plc. is licensed by the Financial Services Commission in Gibraltar under the Financial Services (Insurance Companies) Act to carry on insurance business in Gibraltar, and is authorised to operate in the UK by the Financial Conduct Authority Registration /12/ :12:02 Campbell Page 4 of 4

5 Certificate of Motor Insurance Policy Number ENT/GV CLAIMS HELPLINE GLASS CLAIMS MISFUELLING Registration Marks of Vehicles EX05XOS And any motor vehicle supplied to the policyholder under an agreement between the Insurer and an approved repairer whilst the vehicle shown in a) above is being repaired by that approved repairer as a direct result of damage covered by this policy, unless cover is provided by the approved repairer s own insurance policy 2 Make & Model VAUXHALL COMBO CDTI 3 Name of Policyholder Mr Glen Campbell Effective date of the commencement of insurance for 4 29/12/ :48 the purposes of the relevant law 5 Date of expiry of insurance 22/12/ :59 6 Persons or classes of persons entitled to drive Proposer Only Glen Campbell Those specified above providing that the person driving holds a licence issued by the DVLA to drive the vehicle or has held and is not disqualified from holding or obtaining such a licence and holds any other licence required by law to drive the vehicle for the purpose for which it is being used. 7 Limitations as to use Carriage of goods for hire and/or reward and social, domestic and pleasure purposes for all drivers as stated in 6. above The policy does not cover: Use for commercial travelling, any purpose in connection with the motor trade or use for hiring, racing, pace making, speed testing, off road events, track days, rallies, trials or competitions. Use to secure the release of a motor car, other than the vehicle identified above by its registration mark, which has been seized by, or on behalf or, any government or public authority. I/We hereby certify that the policy to which this Certificate of Motor Insurance relates satisfies the requirements of the relevant law applicable in Great Britain, rthern Ireland, the Isle of Man, the island of Jersey, the Island of Guernsey and the Island of Alderney. Michael Clayden Managing Director Enterprise Insurance Company PLC R22-R24 Ragged Staff Wharf Queensway Quay Gibraltar GX11 1AA This Certificate of Motor Insurance is evidence that you have insurance to comply with the law. It is not valid if altered in any way. For full details of the insurance cover, reference should be made to the policy The insurance evidenced by this Certificate of Motor Insurance extends to include the compulsory motor insurance requirements of: (a) any member country of the European Union; Andorra, the Channel Islands, Gibraltar, Liechtenstein, Monaco, San Marino, Vatican City, Iceland, rway and Switzerland. (b) any other country outside the European Union which has agreed to follow European Directives and is approved by the Commission of the European Union. This is in place of an International Motor Insurance Card (Green Card) and provides cover at least to the minimum extent required by the law of these countries. L'assurance dont fait état cette attestation d'assurance automobile s'étend pour inclure les exigences légales d'assurance automobile de: (a) tout autre État membre de l'union européenne; L Andorre, Îles Anglo-rmandes, Gibraltar, Liechtenstein, Monaco, San Marino, Cité du Vatican, L'Islande, la rvège et la Suisse. (b) tout autre État hors de l'union européenne ayant consenti à suivre les Directives européennes et ayant obtenu l'approbation de la Commission de l'union européenne. Cette attestation remplace la carte d'assurance automobile internationale ("la carteverte") et elle offre au moins la couverture minimum exigée par la loi de chacun de ces pays. Der auf diesem Versicherungsschein ausgewiesene Versicherungsschutz ist erweitert und erfüllt die gesetzlichen Kfz-Haftpflichtversicherungsbestimmungen: (a) jedes Mitgliedslandes der Europäischen Union; Andorra, die Kanalinseln, Gibraltar, Liechtenstein, Monaco, San Marino, Vatikanstadt, Island, rwegen, und in der Schweiz. (b) jedes einzelnen Landes außerhalb der Europäischen Union, das sich zur Einhaltung Europäischer Richtlinien verpflichtet hat und von der Kommission der Europäischen Union zugelassen ist. Dies ersetzt die Internationale Versicherungskarte (die Grüne Karte) und bietet auf jeden Fall die für die jeweiligen Länder gesetzlich geforderte Mindesdeckung. L'assicurazione attestata dal presente Certificato di assicurazione R.C. auto include anche i requisiti obbligatori di assicurazione auto di: (a) qualsiasi altro Paese membro dell'unione europea; la Andorra, Isole del Canale, Gibilterra, Liechtenstein, Monaco, San Marino, la Città del Vaticano, la Islandia, la rvegia e la Svizzera. (b) qualsiasi altro Paese al di fuori dell'unione europea che abbia concordato di osservare le Direttive europee e che sia stato approvato dalla Commissione europea. Questo certificato sostituisce la carta di assicurazione automobilistica internazionale (la carta verde) e provvede la copertura minima richiesta dalle leggi in ognuno di questi paesi. El seguro indicado en este Certificado de Seguro de Automóviles se extiende para incluir los requisitos del seguro de automóviles obligatorio de: (a) cualquier otro estado miembro de la Unión Europea; Andorra, Islas del Canal, Gibraltar, Liechtenstein, Monaco, San Marino, Ciudad del Vaticano, Islandia, ruega, y Suiza. (b) cualquier otro estado fuera de la Unión Europea que haya acordado cumplir con las Directivas Europeas y que haya sido aprobado por la Comisión de la Unión Europea. Esta póliza sustituye a la Tarjeta Internacional de Seguro de Automóviles (Carta Verde) y cumple, al menos, los requisitos mínimos de cobertura de acuerdo con la ley de dichos paises. Advice to Third Parties thing contained in this certificate of insurance affects your right as a third party to make a claim. te: For Full details of the Insurance cover reference should be made to the policy document. Enterprise Insurance Company Plc. Registered in Gibraltar with a registered office at Suite 3, 2nd Floor, Icom House, 1-5 Irish Town, Gibraltar, GX11 1AA. Enterprise Insurance Company Plc. is licensed by the Financial Services Commission in Gibraltar under the Financial Services (Insurance Companies) Act to carry on insurance business in Gibraltar, and is authorised to operate in the UK by the Financial Conduct Authority Registration