Allinz Insurnce plc Motor Trde Select nd RMI Proposl
Business Detils Plese use block letters Full Nme * Address Postcode Telephone Number Detils of risk ddress if different from bove Premises () Address Postcode Telephone Number Premises (b) Address Postcode Telephone Number Plese note, () nd (b) will be used to refer to ech of your premises throughout this proposl form If you hve more thn 2 premises, plese complete n dditionl proposl form Compny Registrtion Number Employee Reference Number (ERN) * If not limited compny show the full nmes nd ddresses of ll principls nd prtners nd ny trding nme. List ny subsidiry compnies to be insured below, nd provide ERN s if different to tht shown bove Number of yers compny hs been estblished Number of yers t risk ddress ) b) Full description of business or trde in detil (include ll spects e.g. body repirs, sprying etc.) Are you member of the Retil Motor Industry Federtion (RMI)? Yes No Wht excess do you require? 350 500 1000 bove plese stte (Plese note your choice of excess will pply to the Mteril Dmge section nd Motor Vehicle Rod Risks section Indemnity 2 Dmge unless otherwise greed) 1
Business Specility Indicte the extent of your specilistion in the types of vehicles referred to under the ctegories to e below nd vehicles you specify under ctegory f by reference to the key below: A = your norml re of trde B = severl times per qurter C = rrely, if t ll (A, B, or C) b c d e motor crs nd light goods vehicles hevy goods vehicles motorcycles buses, coches nd other vehicles designed to crry more thn 8 people griculturl mchinery or mobile plnt f other - specify: Are vehicles sold? Yes No If Yes re you frnchised deler Yes No If Yes wht frnchises do you hold: Give detils of the min mkes nd models nd types of vehicles sold nd/or worked upon: Does the vlue of ny motor cr owned or used by the business exceed 100,000? Yes No If Yes Give detils on Pge 7 (Question 6c) Do you import or sell vehicles tht hve not been type pproved to British or Europen stndrds (Grey Imports)? Yes No If Yes plese provide detils below Do you crry out work wy from your premises other thn vehicle recovery or delivery? Yes No If Yes Plese provide detils below 2
Mteril Dmge Premises () Premises (b) 1 Are your premises built only of brick, stone, concrete, concrete block or uninsulted metl cldding with slte or tile supported by timber frming, metl, sbestos or concrete roof? Yes No Yes No If No, plese provide detils below 2 Are you the sole occupnt of your premises? Yes No Yes No If No, plese provide detils of the other occupnts trdes 3 Are ny prts of the premises unoccupied? Yes No Yes No If Yes, plese provide detils 4 Do you use portble gs/oil heters t your premises? Yes No Yes No If Yes, plese stte number nd type of heters used 5 Is n intruder lrm instlled t the premises? Yes No Yes No If Yes, plese provide detils below Alrm mnufcturer b is the lrm mintined under contrct? Yes No Yes No c is the mintennce compny NSI/SSAIB pproved? Yes No Yes No d e wht is the mintennce compny nme? wht is the signlling method? f does the lrm hve police response? Yes No Yes No If Yes wht level? 3
6 Is proprietry key cbinet instlled t the premises nd secured to the fbric of the building? Yes No Yes No b When the vehicles re left unttended, re the keys nd locking devices removed from ll vehicles on the premises during business hours nd kept in secure loction? Yes No Yes No Are the keys nd locking devices removed from the premises outside business hours or locked in n pproved sfe or proprietry key cbinet? Yes No Yes No 7 Do you require subsidence, ground heve or lndslip cover? Yes No Yes No If Yes, plese complete the following questions b Do the buildings t the premises or neighbouring buildings show ny evidence of dmge from subsidence, ground heve or lndslip (such s crcking or bulging of wlls)? Yes No Yes No Hve the buildings been erected on mde up ground (such s filled pits, rubbish tips nd the like)? Yes No Yes No c Is there history of subsidence or ground heve or lndslip in the re? Yes No Yes No 8 Do you wnt us to quote for Terrorism Cover? Yes No 9 Do you require rectifiction cover? Yes No Mteril Dmge Sums Insured 1 Bsis of cover Choose the bsis of cover required: with sums insured without sums insured Some risks my not qulify for the without sums insured cover bsis. Risks such s clssic / vetern cr delers would fll into this ctegory. Buildings, tennts improvements nd contents re insured on reinsttement bsis. Stock nd vehicles re insured on n indemnity bsis. If you elect for without sums insured option there re no restrictions (prt from inner limits or dditions to the property insured) nor ny limit to the effects of infltion on losses. You must notify us if your floor spce increses by more thn 10%. Sums Insured The Sum Insured selected must represent the full cost of reinsttement of the property to be insured t the commencement of the period of insurnce without djustment for the effects of ny subsequent infltion upon such cost. Allownce should be mde for Architect s, Surveyors nd Consultnts fees nd other dditionl costs involved in reinsttement s result of the need to comply with Public Authority requirements nd the cost of Debris Removl. 2 Property Insured Premises () Premises (b) Buildings (Declred Vlue) Buildings: Include Lndlord s fixtures nd fittings, outbuildings, fixed glss, kiosks, cnopies, fixed signs, wlls, wind turbines, solr pnels (ttched to buildings), gtes, fences, rods, cr prks, yrds, pved res, footpths nd ny min services for which you re responsible. b Tennts Improvements c Loss of Rent receivble / pyble Number of months d Is Index Linking required for Buildings, Tennts Improvements nd All other Property? Yes No 4
Mteril Dmge Sums Insured continued 3 Stock (excluding vehicles) Include spre prts, fuel nd oil stocks nd mterils in trde belonging to you or for which you re responsible. 4 All other Property Include fuel pumps, underground tnks nd ssocited pipes nd cbles, mchinery, plnt nd tools, office furniture, equipment nd records. 5 Vehicles Wht is the percentge vlue of vehicles on your premises overnight i Inside the buildings % % ii In n enclosed nd secure re outside the buildings % % iii Elsewhere in the open % % b Wht sesonl increses re required in connection with your vehicle sum insured? month(s) % % month(s) % % c Do you wish to pply for premium discount, in return for ensuring tht ll unttended motor vehicles re lwys locked nd the keys removed? Yes No 6 Property Limits These re inner limits within the sums insured specified by questions 3,4 nd 5 nd the vlue of the property specified under the property limits must be included within those sums insured. e.g. If the portble hnd tools re vlued t 8,000 nd the remining contents re vlued t 20,000 then the All other Property is 28,000 nd the 10,000 portble hnd tools limit is dequte. If lterntively the portble hnd tools re vlued t 15,000 then the All other Property sum insured would be 35,000 nd the portble hnd tools limit requires incresing from 10,000 to 15,000. Stte the limits you require if the mounts stted ginst the property defined below re insufficient: b 10,000 portble hnd tools (including hnd held electronic vehicle dignostic equipment) 10,000 for ny stock of in vehicle entertinment equipment (whether or not contined in vehicles), MP3 plyers nd mobile phones c 15,000 for ny property whilst in trnsit d 15,000 exhibition cover e 2,500 for ny stock of cigrettes, tobcco, CDs, DVDs, wines & spirits & clothing f 5,000 for the contents of customers vehicles nd personl property in ny other vehicle, whilst in your custody or control g 1,000 for deteriortion of goods 5
Mteril Dmge Sums Insured continued 7 Money Limits Negotible money includes: Csh, bnk nd currency notes, uncrossed cheques, giro cheques including pre-uthenticted giro cheques, uncrossed wrrnts, uncrossed postl nd money orders, current postge nd revenue stmps, Ntionl Svings stmps nd certifictes, holidy with py stmps nd gift tokens, Ntionl Insurnce stmps (whether ffixed to crds or not), debit crd sles vouchers, trding stmps, luncheon vouchers nd bills of exchnge, security for money trvel wrrnts nd uthenticted trvel tickets nd phone crds for use by You or ny prtner, director or employee of You in connection with The Business, consumer redemption vouchers nd compny sles vouchers, nd unexpired units in frnking mchines. Wht limits do you require in respect of negotible money? i On the premises during business hours or in trnsit or in bnk night sfe? ii In locked sfe(s) s specified Mke Mke Model Model Limit Limit b Do you require n increse in the mount of benefit pyble under the Personl Accident Assult cover? Yes No (refer to the policy wording for stndrd limits) Motor Vehicle Rod Risks Bsis of Cover 1 Indicte the bsis of cover required: Comprehensive TPF&T TPO Prtil Comprehensive Premises Premises () Premises (b) 2 Stte the licence numbers of ll trde pltes Business Use Vehicles 3 Stte the number nd (where indicted) crrying cpcity of the following types of vehicle owned by the business nd licensed for rod use Recovery Vehicles i ii cpble of trnsporting 1 vehicle cpble of trnsporting 2 vehicles iii cpble of trnsporting more thn 2 vehicles - stte the number of vehicles which ech cn trnsport b c Pssenger crriers with more thn 8 sets All other vehicles 6
Motor Vehicle Rod Risks continued Lon or Hire 4 Wht is the mximum number of vehicles tht my be used for lon or hire to customers leving their own vehicle for wrrnty work, service or repir - Where customers Insurers provide cover? b To be insured under this policy? Drivers 5 Stte the mximum number of persons who my drive on business Privte Use 6 Do you require cover to be extended to include socil, domestic nd plesure use? Yes No If Yes, How mny of the following types of vehicle my be used for this purpose? i Motor crs stte the mkes of motor crs normlly used ii iii iv v Commercil vehicles up to 2 tonnes plted weight Commercil vehicles over 2 tonnes but not exceeding 7.5 tonnes plted weight Motorcycles Any other Give detils of ny other Privte Use Continued b Stte the mximum number of persons who my be permitted to drive for plesure use? i Aged 17 to 20 ii Aged 21 to 24 iii iv Aged 17 to 20 using motorcycle Aged 21 to 24 using motorcycle c Do you hve ny motorcycles over 500 cc or motor cr(s) Group 29 or over, or re vlued in excess of 50,000? Yes No Yes No If Yes, provide Mke, Model, Age nd Vlue of ech vehicle If you re unsure s to the group rting of vehicle, your insurnce dviser will provide ssistnce s necessry. Vehicle Vehicle Vehicle 7 Do you wish to insure ny vehicles not owned or registered in your compny nme, for use other thn in connection with the business? Yes No If Yes, provide Mke, Model, Registrtion Number nd Vlue of ech Vehicle nd detils of the owner nd registered keeper 7
Motor Vehicle Rod Risks continued Modifiction to Vehicles 8 Hs ny vehicle been tuned or modified to increse its performnce? Yes No If Yes, give detils below Rod Trffic Offences / Helth 9 Hve you or ny person who my drive vehicles with your uthority: In the pst 5 yers been convicted of ny motor offences coded AC, BA, DD, UT, XX, IN, DR, DG, MR, CD40 CD71, CD99, MS50 MS59, TT99 (Disqulifiction), NE99 (Disqulifiction) or ny offences or combintion of offences resulting in disqulifiction from driving or hs prosecution pending in respect of ny of these offences or where their points ccumultion exceeds 6. Convictions spent under the terms of the Rehbilittion of Offenders Act 1974 or ny subsequent mendments, should not be disclosed. Nme Dte of Birth Dte Penlty Circumstnces Rod Trffic Offences / Helth (continued) b Referred ny medicl condition to the Driver nd Vehicle Licensing Agency (DVLA)? If Yes, Give detils including terms or restrictions imposed on their licence by DVLA. Nme Dte of Birth Detils Nmed Driver Bsis 10 Do you wish driving or cover to be restricted to nmed persons? Yes No If Yes, Stte the nmes of the persons concerned A discount will be offered if driving or cover is restricted to nmed persons. This discount is vilble for mximum of 3 drivers nd only when driving restriction is not compulsory feture. Person A Person B Person C 11 Indicte the number of motor certifictes required Unccompnied Demonstrtion 12 Do you wish to include Unccompnied Demonstrtion (subject to cceptnce criteri)? Yes No 8
The Fourth EU Motor Insurnce Directive The Fourth EU Motor Insurnce Directive is designed to improve the clims process for EU citizens who re involved in motor ccidents in other EU member countries. The principle requirement is tht climnt should be ble to identify the relevnt insurer from the Vehicle Registrtion Mrk. This my lso help to combt uninsured driving. In the UK this legisltive requirement is met by the Motor Insurnce Dtbse (MID) which hs been designed to provide record of ll insured motor vehicles registered for use on the rod. Do you currently comply with the present UK legisltive requirements in respect of supplying vehicle dt? Yes No If No, plese provide detils We require ny dditions or vehicle ltertions to be notified within five working dys of ny chnges tking plce. Vrious notifiction methods re vilble. Plese indicte your preferred method from the choices below: Submission of vehicle detils to Allinz (either directly or vi your insurnce dviser) Allinz website (this is the preferred method) b Fx c Post d Emil Or, submission of vehicle informtion directly to the MID by e Mnul entry f Attended File Trnsfer Protocol g Unttended File Trnsfer Protocol If you would like ny clrifiction bout the bove mentioned trnsmission methods contct our Helpline on 0345 0731118 (open 8m 6pm Mondy to Fridy) or visit our MID website t www.llinzmid.co.uk Plese lso provide: Contct Nme: Contct Tel. No: Contct Emil Address: MOT Loss of Licence Cover Do you require MOT - Loss of Licence Cover? Yes No A Motor Trde MOT Loss of Licence Cover Supplementry Proposl Form must be completed. Cover does not ttch until the Supplementry Proposl form hs been ccepted by Allinz. 9
Engineering (Plese complete if you require periodic exmintions of specific plnt or insurnce cover.) The services nd cover under this Section re provided by Allinz Engineering, UKAS ccredited fully independent exmintion uthority meeting the requirements of BS EN 45004 Qulity Stndrd. 1 Frgmenttion Specify ll plnt to be inspected indicting the ctegory of inspection required by reference to the key below: For ny Pssenger Goods / Cr Lifts specified, plese indicte the number of floors served. Exmintion services will be bsed on the list or schedules of plnt provided. The periodicity of exmintions will be in ccordnce with SAFed guidelines unless risk evlution by clients or competent uthority stipulte nother periodicity. If you require more specific exmintions, indicte your requirements by dding the number of exmintions required to the Key code, for exmple CR3. P = Pressure EM = Electricl / Mechnicl CR = Crnes / Lifting Schedule of Plnt Power/Lod P, EM or CR Premises A Premises B (excluding Fuel Pumps) (kw/tones) Number Number 2 Brekdown Is cover required ginst the risk of brekdown of plnt? Yes No 3 Cost of Hiring / Incresed Costs Is cover required ginst the need to hire replcement plnt or otherwise complete work t incresed costs following the brekdown of plnt? Yes No This cover is only vilble if cover extends to include Brekdown (question 2). COSHH Regultions The Control of Substnces Hzrdous to Helth Regultions 1988 extend the scope of exmintion nd the rnge of ventilting plnt requiring inspection. Spry booths nd similr extrction plnt my require inspection under COSHH. Do you require further informtion? Yes No PUWER 98 & LOLER These regultions plce strict requirements on employers to consider the hzrds nd reduce risks connected with use of work nd lifting equipment. They lso introduce dditionl exmintion requirements tht my not be covered under existing exmintion progrmmes. If you would like copy of our Solutions for Complince PUWER 98 & LOLER booklet, plese indicte Yes No 10
Public / Products Libility Complete this Section 1 The stndrd limit of indemnity is 2 million Plese indicte if n lterntive limit is required 5 million 10 million Other 2 Plese stte estimted nnul turnover for the coming yer from Note: Pyments men totl gross remunertion for work done for you including gross wges, slries nd ll other ernings nd llownces (before deduction) Vehicle sles (including trilers nd the like) b Fuel/oil nd sundries c Work involving het ppliction wy from your premises d Brekdown nd recovery opertions e All other business 3 The stndrd limit of indemnity for Products Finncil Loss cover is 250,000 Plese indicte if higher limit is required 4 Do you: Design or mnufcture ny goods? Yes No If Yes plese stte estimted nnul turnover from this ctivity b Export ny goods? Yes No If Yes plese stte estimted nnul turnover from this ctivity If Yes, provide detils where to: c Undertke mnul work in foreign countries? Yes No If Yes plese stte estimted nnul turnover from this ctivity If Yes, supplementry informtion my be requested. Plese provide detils. d Import ny goods (including grey imports)? Yes No If Yes plese stte estimted nnul turnover from this ctivity If Yes, to grey imports, will ll such imports hve Single Vehicle Approvl (SVA)? Yes No If No, plese provide full detils below: 11
Employers Libility Plese complete the following questions if you require Employers Libility cover 5 The stndrd limit of indemnity is 10 million Plese indicte if higher limit is required 6 Plese give estimted totl pyments to employees including lbour only sub-contrctors for the next 12 months for: Clericl stff, commercil trvellers nd mngeril employees who do not engge in mnul lbour b Woodworking, power press, guillotine nd sheet metl mchinery opertors nd their helpers c Brekdown nd recovery opertions d All other mnul employees 7 Totl number of employees Note: Employees include: Persons under contrct of service or pprenticeship Self-employed or lbour only sub-contrctors nd persons supplied by them Persons undergoing work experience Persons hired or borrowed Business Interruption (Plese complete if you require this cover) 1 The stndrd Indemnity Period is 12 months, plese indicte if you wish to extend the period to: 18 months 24 months 36 months 2 Wht is the totl Annul Gross Profit of the business (cross ll loctions) Gross Profit is defined s the Turnover (djusted for the difference in vlues of stock nd work in progress held t the beginning nd end of the finncil yer) less Specified Working Expenses. Specified working expenses re: Purchses, Crrige, freight nd pcking, Discounts llowed nd Bd debts. WARNING: The mount of Gross Profit determined using this definition my be different from tht shown in the Profit nd Loss Accounts of your business 3 The stndrd limit of indemnity for outstnding debit blnces is 500,000, plese indicte if you wish to increse this mount 4 Loss of Liquor Licence Sum Insured 5 Additionl Incresed Cost of Working Sum Insured Additionl Cost of Working This insurnce is for dditionl expenditure incurred in order to minimise ny interruption or interference with the business following loss or dmge to your premises nd property insured under Mteril Dmge. Choice of Indemnity Period 1 The stndrd Indemnity Period is 12 months, plese indicte if you wish to extend the period to: 18 months 24 months 36 months 2 Wht is the totl Additionl Cost of Working Sum Insured (cross ll loctions) Additionl Cost of Working is defined s the dditionl expenditure necessrily nd resonbly incurred by you during the Indemnity Period in order to minimise ny interruption or interference with the business in consequence of the dmge. On uditors fees cover is limited to the resonble chrges pyble by you to professionl ccountnts for producing ny prticulrs or detils contined in your books of ccount or other business books or documents, or other such proofs, informtion or evidence s my be required by us, nd certifying tht such prticulrs or detils re in ccordnce with your books of ccount or other business books or documents. Terrorism Do you wnt us to quote for Terrorism Cover for Loss of Gross Profit or Additionl Cost of Working? Yes No 12
Conversion (Plese complete if you require this cover) 1 Indicte the Limit of Indemnity required 10,000 15,000 20,000 25,000 Specify 2 Stte the estimted turnover during the next 12 months for sles of ll vehicles 3 Are you subscriber to HPI Ltd or Experin Ltd? Yes No 4 Will ll pyments for vehicles not tken in prt exchnge be mde by cheque, credit crd, CHAPS or BACS? Yes No 5 Do you keep ccurte records of ll purchse trnsctions for second hnd vehicles? Yes No Fidelity Gurntee (Plese complete if you require this cover) 1 Indicte the gurntee Limit of Indemnity required 5,000 10,000 Specify 2 Stte the totl number of persons employed persons A Motor Trde Fidelity Gurntee Supplementry Proposl Form must be completed. Cover does not ttch until the Supplementry Proposl form hs been ccepted by Allinz. Commercil Legl Expenses The cover nd hndling of clims under this section re provided by Allinz Legl Protection, prt of Allinz Insurnce plc. Do you require Commercil Legl Expenses cover? Yes No A Motor Trde Commercil Legl Expenses Supplementry Proposl Form must be completed. Cover does not ttch until the Supplementry Proposl form hs been ccepted by Allinz. Personl Accident (Plese complete if you require this cover) 1 Is Personl Accident cover required? Yes No 2 Ctegory of Insured Person Cover required Totl Number of Stff Proprietors, Prtners nd Directors Yes No Employees Yes No Clericl stff, commercil trvellers nd mngeril employees who do not engge in mnul lbour. All other employees 3 Plese insert the benefits required Proprietors, Directors nd Prtners Employees Mximum of 10 units Mximum of 4 units 4 In respect of Proprietors, Directors nd Prtners, is cover required on 24 hour bsis? Yes No Directors & Officers Libility Do you require Directors & Officers Libility cover? Yes No A Motor Trde Directors & Officers Libility Supplementry Proposl Form must be completed. Cover does not ttch until the Supplementry Proposl form hs been ccepted by Allinz. 13
Generl Questions 1 Hve you ever previously been insured in respect of the risks proposed? Yes No If Yes, plese provide the nme of your lst Insurer nd policy number(s) 2 Hs ny insurer ever Declined to insure you or to renew ny of your insurnce policies? Yes No b Cncelled ny of your insurnce policies? Yes No c Avoided ny of your insurnce policies for non-disclosure or misrepresenttion of ny mteril fct? Yes No d Refused to py clim or restricted cover s result of brech of ny policy term or risk improvement requirements? Yes No e Imposed specil terms, conditions or risk improvement requirements? Yes No If Yes to ny of e bove, plese provide detils 3 Hve you or ny prtner ever been either personlly or in ny business cpcity Convicted of or chrged (but not yet tried) with ny criminl offence other thn motor driving offences? NOTE: Convictions spent under the terms of the Rehbilittion of Offenders Act 1974 or ny subsequent mendments thereto, should not be disclosed. Yes No b Declred bnkrupt or entered into n Individul Voluntry Arrngement (IVA) or if compny, gone into liquidtion, dministrtion, receivership, dministrtive receivership, or entered into compny voluntry rrngement or creditors scheme of rrngement? Yes No c A director or prtner of compny tht went into liquidtion, dministrtion, receivership, dministrtive receivership, or entered into compny voluntry rrngement, or creditors scheme of rrngement? Yes No d Prosecuted for brech of ny sttute relting to helth or sfety of employees or others? Yes No e Served with Prohibition Notice under the Helth & Sfety t Work Act 1974 nd ssocited regultions? Yes No f The subject of recovery ction by HM Revenue nd Customs? Yes No g The subject of County Court Judgement or High Court Judgment? Yes No h A director of compny tht hs received County Court Judgement or High Court Judgement ginst it? Yes No If Yes to ny of the bove bove, plese provide detils 14
Generl Questions continued 4 Within the lst 10 yers hve You, or ny Director or Prtner ever trded under different nme? Yes No If Yes plese provide detils Loss / Clim Experience 5 Hve you sustined ny losses or mde ny clims within the lst 3 yers? Yes No If Yes, plese detil ny losses or clims incurred by you. A 3 yer uthenticted experience will be required from your previous Insurer(s). Importnt: It is impertive ll losses or clims (including losses where you did not mke clim) re detiled, even if subsequently declined by your previous insurers. If insufficient spce plese ttch detils on seprte sheet or use the dditionl informtion spce overlef. Yer Detils of loss Cost Pid Cost Outstnding Period of cover required From to noon on 6 Is there ny dditionl informtion or detil which my ssist us in ssessing the nture of the insurnce risk being proposed, nd which my influence our decision to ccept this insurnce, or in setting the terms nd premium? Exmples of such informtion re: ny specil or unusul fcts relting to your insurnce risk ny prticulr concerns which led to you seeking insurnce cover nything tht would generlly be understood to provide fir description of your insurnce risk tking ccount of the nture of your business nd the ctivity undertken t your premises or elsewhere If Yes plese provide detils Yes No Cover will not commence until we hve ccepted this proposl or greed to hold covered 15
IMPORTANT INFORMATION YOUR DUTY TO MAKE A FAIR PRESENTATION OF THE RISK You must mke fir presenttion of the risk to us t inception, renewl nd vrition of your Policy. This mens tht you must tell us bout ll fcts nd circumstnces which my be mteril to the risks covered by your Policy in cler nd ccessible mnner or give us sufficient informtion to lert us of the need to mke enquiries bout such fcts or circumstnces. Mteril fcts re those which re likely to influence us in the cceptnce of or ssessment of the terms or pricing of your Policy. If you re in ny doubt s to whether fct is mteril, you should tell us bout it. If you fil to mke fir presenttion of the risk, we my void your Policy (tht is tret it s if it hd not existed) nd refuse to py ny clims where ny filure to mke fir presenttion is: deliberte or reckless; or b of such other nture tht, if you hd told us bout mteril fct or circumstnce, we would not hve issued, renewed or vried your Policy. IMPORTANT INFORMATION YOUR DUTY TO MAKE A FAIR PRESENTATION OF THE RISK continued In ll other cses, if you fil to mke fir presenttion of the risk, we will not void your Policy but we my insted: b reduce proportiontely the mount pid or pyble on ny clim, the proportion for which we re lible being clculted by compring the premium ctully chrged s percentge of the premium which we would hve chrged hd you mde fir presenttion (e.g. if we would hve chrged you double the premium, we will only py hlf the mount of ny clims under your Policy) nd/or tret your Policy s if it hd included such dditionl terms s we would hve imposed hd you told us bout mteril fct or circumstnce. Pyment of ny clim you mke will be subject to the ppliction of ny such dditionl terms. For these resons it is importnt tht you check ll of the fcts, sttements nd informtion set out in this proposl re complete nd ccurte. You must lso mke resonble enquiries to check with nyone you employ in your business tht the fcts nd sttements set out in this form re complete nd ccurte. IF ANY OF THE FACTS, STATEMENTS AND INFORMATION SET OUT IN THIS PROPOSAL ARE INCOMPLETE OR INACCURATE, YOU OR YOUR INSURANCE ADVISOR MUST CONTACT US IMMEDIATELY. FAILURE TO DO SO COULD INVALIDATE YOUR POLICY OR LEAD TO A CLAIM NOT BEING PAID OR NOT BEING PAID IN FULL 16
Declrtion I/we declre tht: 1 I/we hve red this proposl nd understnd tht I/we re under duty to mke fir presenttion of the risk nd tht filure to do so could result in my/our Policy being invlidted nd/or clim not being pid or not being pid in full. 2 the fcts, sttements nd informtion contined within this proposl, whether provided by me/us or by others on my/our behlf, re true nd complete. 3 ny fcts, sttements nd informtion which re not contined within this proposl but which hve been provided to Allinz seprtely by me/us or by others on my/our behlf re true nd complete. 4 I/we hve declred ll mteril fcts informtion nd circumstnces which my ffect the risk being ccepted by Allinz under this Policy even if Allinz hs not sked me/us ny questions bout such fcts informtion nd circumstnces. 5 I/we hve mde ll resonble enquiries of nyone employed by me/us to ensure tht ll fcts, sttements nd informtion provided to Allinz re ccurte nd correct. 6 I/We gree to ccept Allinz Insurnce plc's stndrd form of policy for this/these clss/clsses of insurnce. A specimen copy of the policy is vilble on request. 7 I/We understnd tht Allinz Insurnce plc nd/or Allinz Legl Protection reserve the right to decline ny proposl. 8 I/We hve red the Dt Protection sttement on pge 18 of this proposl nd consent to dt being used for the purposes specified. Authorised Signture Dte Position/Title Print Nme Importnt Your Records You should keep record (including copies of letters) of ll informtion supplied to Allinz which reltes to this proposl. A copy of this proposl will be supplied on request. 17
Dt Protection Allinz Insurnce plc together with other compnies within the Allinz SE group of compnies ( Allinz Group ) my use the personl nd business detils you hve provided or which re supplied by third prties including ny detils of directors, officers, prtners nd employees (whose consent you must obtin) to: provide you with quottion, del with the ssocited dministrtion of your policy nd to hndle clims; serch credit reference, credit scoring nd frud gencies who my keep record of the serch; shre with other insurnce orgnistions to help offset risks, dminister your policy, for sttisticl nlysis, nd to hndle clims nd prevent frud; support the development of our business by including your detils in customer surveys, for mrket reserch nd business reviews which my be crried out by third prties cting on our behlf. Allinz Group my need to collect nd process dt relting to individuls who my benefit from the policy ( Insured Persons ), which under the Dt Protection Act is defined s sensitive (such s medicl history of Insured Persons) for the purpose of evluting the risk nd/or dministering clims which my occur. You must ensure tht you hve explicit verbl or written consent from the Insured Persons to such informtion being processed by Allinz Group nd tht this fct is mde known to the Insured Persons. If your policy provides Employers Libility cover informtion relting to your insurnce policy will be provided to the Employers Libility Trcing Office (the ELTO ) nd dded to n electronic dtbse, (the Dtbse ) in formt set out by the Employer s Libility Insurnce: Disclosure by Insurers Instrument 2010. The Dtbse ssists individul consumer climnts who hve suffered n employment relted injury or disese rising out of their course of employment in the UK whilst working for employers crrying on, or who crried on, business in the UK nd s result re covered by the employers libility insurnce of their employers, (the Climnts ): I. to identify which insurer (or insurers) ws (or were) providing employers libility cover during the relevnt periods of employment; nd II. to identify the relevnt employers libility insurnce policies. The Dtbse nd the dt stored on it my be ccessed nd used by the Climnts, their ppointed representtives, insurers with potentil libility for UK commercil lines employers libility insurnce cover nd ny other persons or entities permitted by lw. The Dtbse will be mnged by the ELTO nd further informtion cn be found on the ELTO website www.elto.org.uk If your policy provides Motor cover, informtion relting to your insurnce policy will be dded to the Motor Insurnce Dtbse ("MID") mnged by the Motor Insurers Bureu ("MIB"). MID nd the dt stored on it my be used by certin sttutory nd/or uthorised bodies including the Police, the DVLA, the DVANI, the Insurnce Frud Bureu nd other bodies permitted by lw for purposes not limited to but including: I. Electronic Licensing II. Continuous Insurnce Enforcement; III. Lw enforcement (prevention, detection, pprehension nd or prosecution of offenders) IV. The provision of government services nd or other services imed t reducing the level nd incidence of uninsured driving. If you re involved in rod trffic ccident (either in the UK, the EEA or certin other territories), insurers nd or the MIB my serch the MID to obtin relevnt informtion. Persons (including his or her ppointed representtives) pursuing clim in respect of rod trffic ccident (including citizens of other countries) my lso obtin relevnt informtion which is held on the MID. It is vitl tht the MID holds your correct registrtion number. If it is incorrectly shown on the MID you re t risk of hving your vehicle seized by the Police. You cn check tht your correct registrtion number detils re shown on the MID t www.skmid.com Telephone clls my be recorded for our mutul protection, trining nd monitoring purposes. Under the Dt Protection Act 1998 individuls re entitled to request copy of ll the personl informtion Allinz Insurnce plc holds bout them. Plese contct the Customer Stisfction Mnger, Allinz Insurnce plc, 57 Ldymed, Guildford, Surrey, GU1 1DB. Personl detils my be trnsferred to countries outside the EEA. They will t ll times be held securely nd hndled with the utmost cre in ccordnce with ll principles of English lw. By pplying for nd/or entering into this insurnce policy you will be deemed to specificlly consent to the use of your dt nd your insurnce policy dt in this wy nd for these purposes nd tht your directors, officers, prtners, nd employees hve consented to our using their detils in this wy. Additionl Informtion Plese use this spce to provide ny further informtion 18
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www.llinz.co.uk Allinz Insurnce plc. Registered in Englnd number 84638. Registered office: 57 Ldymed, Guildford, Surrey, GU1 1DB, United Kingdom. Allinz Insurnce plc is uthorised by the Prudentil Regultion Authority nd regulted by the Finncil Conduct Authority nd the Prudentil Regultion Authority. Finncil Services Register number 121849. ACOM188_11 09.16