ROAD RISKS PROPOSAL FORM

Transcription

1 ROAD RISKS PROPOSAL FORM Granite Underwriting limited Form GU-VRR002

2 Daniel House, 36 Chapel Lane, Formby, Merseyside L37 4DU Completed proposal forms should be returned to the above address. Data Protection Act. Information about you, this application and any Policy and Certificate issued may be retained by us on our computers and that information may be: a. Disclosed to and or recorded by other persons for the purpose of our business, and b. Other organisations including but not restricted to Insurance Companies, your Agent, the Police, the Department of Transport, the Motor Insurers Bureau may access data held by Granite Underwriting. c. We may search various databases to help prevent fraud. A record of our search may be provided to other organisations carrying out similar searches Cover does not attach unless this proposal form has been accepted by Granite Underwriting and the premium has been paid. Please check the information in this proposal THOROUGHLY. Any missing information should be added so that all sections are fully completed, and adjustments should be initialled. This proposal forms the basis of the contract between the Policyholder(s) and Granite Underwriting on behalf of the Underwriter(s) subscribing to this Insurance. Section A - Proposer Details 1. Full name including trading name or name of Limited Company Full name of proposer Company or Trading Name (if applicable) Full Business Description Business Address - (this is the address where you carry on your motor trade business activities) Post Code address: Web site (if applicable) Telephone: Business Mobile Home Is the business address above also your Private Domestic Residence (Home)? Yes No Please indicate with a tick the business status of the Proposer Limited Company Company Registration No. Sole Trader Partnership Number of partners Limited Liability Partnership Company registration No. Are you registered for VAT? Yes No If Yes, what is your VAT Registration number Correspondence address if different from Proposer s business address above Post Code 1 Full Name 2 Full Name 2. Period of Insurance Day Month Year Day Month Year From To Page 1

3 Tell us about your involvement in the Motor Trade 3 (a) Are you a Full Time Motor Trader? Yes No 3 (b) Do you have any other occupation, either full or part time? Yes No (If no got to question 4) If the answer to 3(b) above is Yes, please provide full details below: In this other occupation are you: Employed or Self Employed 4. Please describe fully your involvement in the motor trade a) Activity b) further details about your activity Vehicle Sales % How many vehicles are handled in any one year Vehicle repairs % Approximate annual turnover of your business Breaking / second hand parts % Vehicle recovery % Vehicle collection / delivery % Gross Vehicle Weight Limit required Up to 3500kgs Yes No Valeting / Steam cleaning % Up to 7500kgs Yes No Leasing or Repossession % Up to 44 tons Yes No % 4 c Where do you trade from? % Home Workshop % Enclosed Yard Forecourt Other activity - detail below Yes No % Shared premises Lock up Showroom Mobile Total 100% Other (specify) 5. a) How many years have you been trading under the entity to be Insured herein? C) Approximately when was the business established TYPES OF VEHICLES TO BE COVERED 6. What types of Vehicles do you handle in your business? (Please tick all that apply) Tick which vehicles you are involved with in your business and indicate approximately what percentage of your turnover relates to each 6.1 Standard Private cars/vans to 3500kg % 6.3 Sports / High performance vehicles % If dealing in these, please see your quotation for special terms. 6.5 Commercial vehicles up to 7,500kgs % 6.6 Commercial vehicles over 7,500kgs % Page 2

4 6.8 Motorised Horseboxes % 6.12 Imports / Export of Vehicles % Being driven on trade plates or UK registered only. Otherwise excluded Vehicle transporters Number of transporters Max. GVW Limit required Tonnes 6.15 Kit cars Cover is Third Party Only 6.16 Motor Cycles / Quad bikes Cover is excluded, but may be included by extension 6.17 Other vehicles Provide further details of other types below 7. Where are vehicles kept overnight?: - please tick all the apply below a. Don t keep any at night b. Keep them in my garage at my home c. Keep them on my driveway d. Leave them on the road e Keep them inside my secure trade premises f. Other B Section B DRIVERS Important Note: Please see Summary of Cover for an outline of the insurance and limits available under this section. 9. Drivers - (ALL drivers must be named including the proposer ) Name Date of Birth Full UK Licence held Driving Licence number Status (Driver code) * Use B/C/P/OB ** Page 3

5 10. MOTORING CONVICTIONS - Have you or any person named or described in section B (9) above been: Yes or No a) convicted of any motoring offence or have any prosecution pending in the past five years? b) disqualified from driving in the past 11 years? If Yes to a or b above please provide full details below Driver Date of Conviction Conviction Code Penalty points Disqualification period (months) 11. NON-MOTORING CONVICTIONS**** Have you or any person named or described in section B (9) above: Yes or No a) been convicted of any criminal offence or have any criminal prosecution pending? b) received an official caution from Police? c) been discharged dishonourably from HM Forces? If Yes to 11 (a) or 11 (b) please provide full details below: Driver Offence Conviction or Caution date * Do you or did you admit the offence? (yes or no) Penalty Imposed (***) Include details of any prison sentence imposed, fines or other sanctions, whether community service order or curfew or any other sanction. In most cases, we shall require further information on form GUXO-001 **** Rehabilitation of Offenders Act 1974 You are not required to disclose certain offences once they become spent under the terms of the Rehabilitation of Offenders Act The terms under which offences become spent can be complicated. If in doubt, please seek legal advice. 13 MEDICAL HISTORY - Have you or any person named in section B above ever suffered from a) defective vision or hearing (if not corrected by glasses, contact lenses or hearing aid? Yes or No b) any heart condition, epilepsy, blackout(s), fit(s) or diabetes? c) any other physical or mental condition which you must notify D.V.L.A. If Yes to any of the questions in 2.4 above, please provide details below Page 4

6 14 Accident and Claims History Within the past FIVE years, have You or anyone else who will drive: a. been involved in any road traffic accident or suffered a fire or theft loss or a loss as a result of malicious damage or vandalism regardless of whether or not a claim was made or whether or not the loss was covered by insurance? Yes No If the answer to Section 14 (b) is Yes then please provide full details below: Driver Name Date of Incident Incident Code (see codes below) Was bonus effected? (Yes / No) Estimated Cost Brief Details 15 Previous Insurance History Have you ever held any type of motor insurance in your own name previously Yes No a) If Yes The name of your previous insurance company (NOT your broker) Your Policy number when you were with your previous insurer Expiry Date What type of policy did you have: Motor Trade Private Motor Commercial Vehicle Taxi - Public / Private Hire Motorcycle Fleet or other type Number of years claims free b) If the answer to question 15 is No please tell us: Have you ever driven under anyone else s Insurance? Yes No If Yes please provide: Name of Person whose Policy insured You Type of Policy e.g. Private car or commercial 16. Introductory Discount An Introductory Discount may be allowed if the proposer(s) has / have not previously held motor trade insurance, but has / have previously held either Private Motor or Commercial Vehicle insurance AND have been claims free for a minimum of THREE years. Are you claiming an Introductory Discount? Yes No Number of years claim free claimed If Yes please attach evidence in the form of your previous insurer s original renewal notice NOTE: No claims discount entitlement is only valid if your previous policy expired within the past 30 days. If there is a gap between the expiry of your previous policy and the start of this policy please provide a full explanation below. Page 5

7 D Vehicles to be Covered 17. Vehicles Owned - Cars and light vans (include vehicles held for sale) Make & Model Year of Make Date of Purchase Sale vehicle or Own Use? Present Trade Value Registration Number Vehicles owned - please list ALL vehicles owned with a gross vehicle weight in excess of 3.5 tonnes Make & Model Gross Vehicle Weight Type of Body Number of vehicles carried (see note 2) Present Value Registration Number Note 2 Include vehicles carried on the transporter and towed behind or on any trailer attached trailer Does any vehicle have a Hi-Ab or other mechanical / hydraulic lifting capability? Yes No E Cover and Indemnity Limits 18. Cover Please select the cover you require Select your excess (minimum 250) Comprehensive Third Part Fire & Theft (maximum value 15,000) Third Party Only Please note: the minimum excess is 250. This will apply in addition to any other excess shown in the Schedule for any young or inexperienced driver Certain vehicle types are restricted to Third Party cover. These are detailed hereunder and in your quotation. 19. Indemnity Limits What indemnity limit do you require? a. The maximum value of any ONE vehicle you own c. Value of ALL Vehicles you own b. The maximum value of any ONE customer Vehicle d. Value of ALL customer vehicles e. What is the maximum number of Vehicles you will own at any one time? f. What is the maximum number of Customers Vehicles you will have at any one time? The Indemnity Limit at (a) above is the Maximum we shall pay for any one loss, or series of losses arising from one cause and in the period of Insurance for any vehicle belonging to the Policyholder. This limit will also apply to any one Vehicle. The Indemnity Limit at (b) above is the Maximum we shall pay for any one loss, or series of losses arising from one cause and in the period of Insurance for any Vehicle belonging to the Policyholder s customer. This limit will also apply per Vehicle. Page 6

8 F Optional Extensions to Standard Policy Cover PLEASE NOTE ANY ADDITIONAL COVERS SELECT IN ADDITION TO THOSE SELECTED AT QUOTATION STAGE WILL NOT BE ADDED TO THE POLICY UNLESS CONFIRMED BY THE UNDERWRITER 1 Accompanied Demonstration Yes No Level of Cover Required Third Party Only Comprehensive 2 Customer Loan/Hire Do you require this cover? Yes No Level of Cover Required Third Party Only Comprehensive 3 Motor Cycles / Quad bikes Do you require this cover? Yes No Third party only Comprehensive Cc Limit Required 50 cc 250 cc Unlimited Please provide details re Motorcycles 4 Trade Plates Yes No Trade Plate Nos. 5 Additional Business Use Do you require this cover? Yes No Business Description 1 st Driver Name 2 nd Driver Name 7. Vehicles in Transit Do you require this cover? Yes No Maximum value any one vehicle Transporter Reg. No. / Trailer Serial number Total Load Value 8. Specified Trailers Max number of vehicles carried any one time Do you require this cover? Yes No Trailer serial number Trailer serial number Value Value Page 7

9 H General Questions and Other Information 5.4 Either personally or in any business capacity, have you or any director or business partner in the business proposed ever been Convicted of or charged (but not yet tried) with any criminal offence other than a motoring offence? Yes No Declared bankrupt or insolvent? Yes No A director or business partner in any business within 12 months of the appointment of an official Receiver or liquidator or dissolution through insolvency? Yes No If Yes to any of the questions at 5.4 above, please provide full details below Material Facts Failure to disclose a material fact (any fact which may influence the Underwriters assessment of the risk proposed herein) will render this insurance voidable. If you are in doubt about facts which might be considered material you should disclose them. You are advised to keep copies of all information supplied for the purpose of entering into the contract. Please note that insurers maintain a Motor Insurance Anti- Fraud Register and exchange information with each other to prevent fraudulent claims. Are there any material facts you should disclose? Yes No If Yes please provide details below Page 8

10 Declaration I/WeI I/We declare that to the best of my/our knowledge and belief all the above statements are true and complete. I/we understand it is my/our duty to disclose all facts which are material to and which will influence the acceptance and/or assessment of the proposal and that I/we must notify immediately any changes to the information provided herein. I/we further understand that at each r enewal of my/our policy or if any changes occur during the policy period it is my duty to disclose any changes immediately to the information provided herein and any other facts which are material to and which will influence the acceptance and assessment of the policy. I/we understand that the failure to do so means that the policy may not operate to protect me. I / We agree to maintain and operate all security equipment including intruder alarm systems in accordance with the conditions set out in the Schedule of Insurance, and to advise Service Motor Trade Policies immediately if for any reason I / We cannot comply or if I / We are served a notice or warning of non-response by the relevant police authority. I/we AgreeI / We agree that this proposal and declaration shall form the basis of the contract between me/us and the Insurer(s) and That if any other person has written any answer, such person shall be deemed to be my/our agent for that purpose. If this Proposal has been completed by your agent based on the information supplied by you the proposer, it is your responsibility to ensure the questions are answered correctly and truthfully to the best of your knowledge. Advise your Agent immediately in writing if any of the information is incorrect, or if during the course of this insurance your circumstances change in any way material to this risk. Proposer's Signature(s) Print Name here Capacity in which signed (Please delete whichever does not apply) Proposer Partner Director Date Signed Page 9

11 Notice to Proposer's IMPORTANT: We supply information contained within his Proposal to the Motor Insurer s Information Centre Database to help detect people who break the law by not taking out insurance. The police and all Insurers have access to this database, we also subscribe to the Claims and Underwriting Exchange Register operated by Insurance Database Services Limited and the Motor Insurer s Anti-Fraud and Theft Register. In the even of a claim, the information you supply on this form and any claim form, together with information relating to the claim, will be put on the registers and made available to participants. We will make a search with a credit reference agency, which will keep a record of that search and will share that information with other businesses. We may also make enquiries about the principal dir ectors with a credit reference agency. You should show this notice to anyone insured to drive under the policy. LAW to be Applied THE THIRD EC NON-LIFE DIRECTIVE REQUIRES US TO PROVIDE YOU WITH THE FOLLOWING INFORMATION BEFORE PURCHASE: Contract Law Applicable The parties to the contract are free to choose the law which will apply. Unless specifically agreed to the contrary, the insurance will be subject to the Law of England, Wales, Scotland or Northern Ireland depending on where the risk is situated. Security This Insurance is Underwritten by Granite Underwriting Limited on behalf of Haven Insurance Company Limited. Haven Insurance Company is licenced by the commissioner of Insurance under the Insurance Companies Ordinance to carry on Insurance business in Gibraltar, and approved under the special passporting arrangements by the Financial Services Authority to Underwrite certain classes of Insurance in the United Kingdom. You may inspect the Financial Service Authority register at COMPLAINTS It is always our intention to provide a first class service. However, if you have any cause for complaint, you should, in the first instance contact either Granite Underwriting Limited at the address shown below. Should you remain dissatisfied, the following options are open to you : Contact Haven Insurance Company Limited or contact the Financial Ombudsman Service (FOS) Contact names and address's Granite Underwriting (Haven Insurance Company s UK Agent) Daniel House, 36 Chapel Lane, Formby, Merseyside L37 4DU Telephone xxxxxxx Registered with the Financial Services Authority No Haven Insurance Company Limited Suite 913B, Europort, Gibraltar Registered with the Financial Services Authority No The Financial Ombudsman Service South Quay Plaza 183 Marsh Wall, South Quay, London E14 9SR The existence of the above does not affect any legal right you may have. Page 10