Tradesman Insurance Statement of Fact Policy Number: POWT0001682/Y103034QBE0116A Period of Insurance: From: 00.00 hours on 21/06/2016 To: 24.00 hours on 20/06/2017 Broker: Insured: Trade Direct Insurance Services Ltd Landlords Certificate Ltd Subsidiary Companies: None Address: 11 Hatch Lane E4 6LP Business Description: Plumbing And Heating Engineer - Domestic/Small Commercial Only Please read the following information carefully This document sets out the important information that you, or your insurance broker on your behalf, have provided to us and we rely on it in assessing your insurance cover. It is very important that it remains up to date and is correct if it isn t, then it could invalidate or your insurance result in a claim being denied. What you need to do next Please check that the information set out below in the Key information section is correct. If the information is correct If the information is correct you don t need to return this document or take any further action simply keep this document in a safe place together with your other policy documents. We will treat this as your confirmation that the details below are correct and accurately reflect your insurance requirements. By paying the premium requested, you are accepting the terms offered contained in this document, the policy summary, the schedule and policy documentation. If the information is incorrect If any of the details are incorrect or anything is unclear, please notify your insurance broker immediately. We will advise you of any changes to your policy, including the premium payable, or any additional information we require to assess your insurance, and we will then issue you with a new statement in place of this document. Please also read the Confirmation, Privacy Statement and Important Notes the end of this document.
KEY INFORMATION Client Details: Name of Insured: Landlords Certificate Ltd Address: 11 Hatch Lane E4 6LP Legal trading status: Is Company ERN Exempt: Employer Reference Number (ERN) Subsidiary Companies: Ltd Company No 120/aa91235 None General Information: Years Trading: 3 Annual Turnover: 760,000.00
Declaration of facts: No principal, partner or director in the business has ever been prosecuted under any safety legislation during the last 5 years and no such notices are pending No principal, partner or director in the business has ever been convicted of or charged (but not yet tried) with any criminal offence other than motoring offences The business, or any director or partner of this business: o In relation to this business o In relation to any other business o In a personal capacity has ever been declared bankrupt or insolvent or been a director of any company or organisation that has gone into liquidation, administration or receivership No principal, director or partner in the business has ever had a proposal for insurance refused or declined or ever had an insurance cancelled, renewal refused or had special terms imposed The business does not involve: handling or use of silica, asbestos or substances containing asbestos, acids (other than brick acid), gases, explosives, radioactive or similar dangerous liquids or substances, demolition or partial demolition unless you are rebuilding There is no work offshore Trade Specific Questions: Does the business use fixed Powered Wood Working Machinery (portable hand held power tools are acceptable)? No Trade: Primary Trade - Description Plumbing And Heating Engineer - Domestic/Small Commercial Only Primary Trade - Percentage 100% Maximum Height Limit (in metres): 0 Maximum Depth Limit (in metres): 0 Phase 3 Electrical Work Undertaken Not Declared Heat work away No Employees: Total number of people working in the business, including all partners, principals, proprietors, 6
directors, employees and subcontractors: Employee Detail: Total number of people doing manual work including LOSC's / Principals / Proprietors / Partners / Directors: Total number of people doing clerical work including Principals / Proprietors / Partners / Directors / Administration staff: Public and Products Liability Limit of Indemnity: 5M Third party property damage excess: 500 1 5 Employers Liability Limit of Indemnity: 10,000,000 Contractors All Risks Contract Works - Sum insured 0 Hired In Plant - Sum insured 0 Annual Hiring Charges 0 Own Plant - Sum insured 0 Tools - Limit per person 0
You do not have to return this form If you are satisfied that the information set out in this form is correct and you have disclosed all the relevant details, you do not need to return this document. Please keep it in a safe place with your policy documents If any of the details are incorrect or anything is unclear, you must inform your insurance broker within seven days and they will advise you if the changes(s) affect the acceptability and/or premium of this insurance. CONFIRMATION We rely on the information set out above in assessing your insurance cover. By not returning this form and subsequently paying the premium you are taken to confirm the details set out in the Key Information section above, whether given by you or by your insurance broker on your behalf, are complete and true and that you have not withheld any information. If information detailed in this document has been provided on your behalf, you agree the person is deemed to be your agent and not an agent for QBE Insurance (Europe) Limited and that you have read and verified the information provided PRIVACY STATEMENT Any personal information provided when applying for this policy or in connection with its administration, including the notification and handling of any claim, will be recorded and processed by us in accordance with the Data Protection Act 1998. If the personal information includes sensitive personal data (such as health details or details of criminal convictions) you consent to the information being used for the purposes and being disclosed to the parties listed under the Important Notes overleaf. Where personal information is provided about another person, you confirm that such person has been informed of our identity, the purposes for which their personal data will be processed and the disclosures which may be made (each as set out in the Important Notes ) and they have consented to the processing of their personal information (including sensitive personal data) in this way. IMPORTANT NOTES You should keep a complete record of all information supplied to us (see insurer information under), including copies of all letters. Full details of your policy terms and conditions are available on our website at www.qbeeurope.com. Alternatively, please ask your insurance broker for a full copy of the policy. Insurer information QBE Insurance (Europe) Limited (registered in England number 1761561; Home State United Kingdom. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority; registration number 202842) QBE Underwriting Limited is the managing agent of QBE Casualty Syndicate 386 at Lloyd s; QBE Syndicate 1886 at Lloyd s and QBE Property Syndicate 200 at Lloyd s. QBE Underwriting Services (UK) Limited (company number 02262145) is an Appointed Representative of QBE Underwriting Limited (company number 01035198). Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority; registration number 204858. The registered address for all the above is: Plantation Place, 30 Fenchurch Street, EC3M 3BD. Fraud Act 2006 If you provide an answer/information which you know is untrue, or deliberately fail to provide information that we have requested (e.g. previous accidents) you may be committing a criminal offence. Claims and Underwriting Exchange Your details and those of anyone insured under this policy, who must be made aware of this, may be passed to the Claims and Underwriting Exchange Register (CUE) which are run by Insurance Database Services Ltd (IDSL). We will use the information obtained from these registers to validate your claims history. Under the conditions of your insurance policy with us, 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 above registers. We also exchange information with the Police and/or other Insurers and/or other organisations through various other databases in order to check information provided and prevent fraudulent claims. If false or inaccurate information is provided, or similar applications have been made to other insurance companies and fraud is identified, details will be passed to fraud prevention agencies and other insurance companies to prevent fraud and money laundering. Further details explaining how the information held by fraud prevention agencies may be used and details of the organisations data is shared with can be obtained by visiting www.qbeeurope.com, e-mailing dpa@uk.qbe.com or writing to DPA, QBE Insurance (Europe) Limited, One Coval Wells, Chelmsford, CM1 1WZ or telephoning 01245
272700. Choice of contract law UK law allows both you and us to choose the law and jurisdiction applicable to the policy. Unless it is agreed otherwise, the law that applies to this contract is the law of that part of the United Kingdom where your principal premises is located. In addition any legal proceedings between you and us in connection with this contract will only take place in the courts of that part of the United Kingdom where your principal premises is located and are subject to the exclusive jurisdiction of that court. Data Protection Act Any personal information provided when applying for this policy or in connection with its administration, including the notification and handling of any claim, will be recorded and processed by us in accordance with the Data Protection Act 1998. If the personal information includes sensitive personal data (such as health details or details of criminal convictions) you consent to the information being used for the purposes set out below and being disclosed to the parties listed below. Where personal information is provided about another person, you confirm that such person has been informed of our identity, the purposes for which their personal data will be processed and the disclosures which may be made (each as set out below) and they have consented to the processing of their personal information (including sensitive personal data) in this way. Personal information is used for the following purposes: a) to administer the policy, including underwriting, claims handling and issuing renewal information and documentation; b) to carry out research and analysis and create statistical and testing information and for the purposes of customer profiling (including with transactional information); c) to help prevent and detect fraud or loss and recover debt; d) where required or permitted by law. Personal information may be disclosed to the following third parties: a) other members of the QBE Insurance Group for the purposes set out above. A list of companies in the QBE Insurance Group is available on request; b) other insurers and reinsurers of the risk written under this policy and your broker; c) agents and service providers appointed by us to carry out activities in connection with the policy including claims handling and investigative agents and general service providers including providers of IT systems and maintainers; d) credit reference and fraud databases and law enforcement bodies; e) potential purchasers of the whole or part of the business. We may share information with other firms and public bodies, including the police and statutory and/or authorised bodies, in order to substantiate information, law enforcement, electronic licensing and to prevent or detect fraud, by accessing and updating various databases. If false or inaccurate information is provided and fraud is suspected, this fact will be recorded and the information will be available to other organisations that have access to the databases. Details of databases accessed or contributed to are available on request. Personal information may be transferred to third parties in countries outside the European Economic Area which may not have the same standards of protection for personal data as the UK. We will ensure that such transfers comply with data protection law and that the personal information is kept securely and protected from unauthorised access. We maintain physical, electronic and procedural safeguards to protect your personal information and follow strict security procedures in the storage and disclosure of personal information to safeguard the data and prevent unauthorised access to or loss of such information. We may monitor and record communications with you (including phone conversations and emails) for compliance and quality control purposes.
Should you wish to receive a copy of the information held or if there are any queries in relation to the way such information is used or any inaccuracies in the data you should write to the Data Protection Officer at QBE Insurance (Europe) Limited, Plantation Place, 30 Fenchurch Street, EC3M 3BD.