TRUCK. Proposal form. Truck Insurance. Important notes. General

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1 Proposal form TRUCK Insurance Truck Insurance Your Insurance Adviser will give you guidance in relation to your insurance and can provide you with a specimen of the policy which contains full details. This is a short summary of the main benefits, limitations and information we are required to give you. The Schedule will state any particular restrictions and endorsements which apply in your case. Important notes Disclosure of Information Making false statements, failing to reveal or withholding relevant information is illegal when done to obtain a Certificate of Insurance and can make the Insurance invalid. This may result in any claim not being paid and us seeking repayment of any amount we are legally required to pay to third parties. If you are not sure whether you need to tell us about certain facts, you should provide the information regardless or contact your Insurance Adviser for advice. You must keep us informed of any changes likely to affect your insurance. Your attention is drawn to the Declaration on the Proposal Form concerning the accuracy of information given. If the Proposal Form has been completed by a person other than you, it should be read very carefully, or you should ask someone to explain it to you, before signing. Coming into Effect We reserve the right to refuse any Proposal and to apply special terms and conditions. The Insurance is not operative until a Certificate of Insurance or Cover Note has been delivered to you. All cover ceases when the Cover Note or Certificate expires or following cancellation. Data Protection Act It is important that you read the attached Data Protection Notice, or that someone explains it to you. This is shown in full in the Policy and your Insurance Adviser can provide you with a copy. The Notice must be shown to any party related to the insurance. It explains how we may use and share your details, and tells you about the systems and registers that we and others have in place, which can be searched to ascertain policy information and to help us to detect and prevent fraudulent applications and claims. When you tell us about any incident, whether or not it results in a claim, information about it will be passed to the registers. We may search these when you apply for insurance, at renewal or in the event of an incident which may result in a claim. All telephone calls relating to applications and claims may be recorded and the recordings used for the purposes of fraud prevention, training and quality control. If you have any queries, or would like more information about the Data Protection Notice or a copy of the personal data that we hold about you, please write to the Customer Care Department, Highway Insurance, Highway House, 171 Kings Road, Brentwood, Essex CM14 4EJ, customercare@highway-insurance.co.uk. For more information on the Data Protection Act you may also write to the Office of the Information Commissioner at Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF. Telephone: Complaints We aim to provide a high standard of service, but in the event you are dissatisfied with the service you receive, you should in the first instance contact your insurance adviser who sold you this insurance. If you remain dissatisified you should contact the Customer Care Department, Highway Insurance, Highway House, 171 Kings Road, Brentwood, Essex CM14 4EJ. For full details, consult your Insurance Adviser Please detach and keep this prospectus for future reference Telephone: customercare@highway-insurance.co.uk Please quote the Policy Number in all correspondence. A copy of Highway s complaint handling procedure is available on request. If we cannot resolve your complaint, you may refer your complaint to the Financial Ombudsman Service within six months of receiving our final response letter. The address is: Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London, E14 9SR. Telephone: or (from mobile or non BT lines) complaint.info@financial-ombudsman.org.uk Making a complaint will not affect your right to take legal action. General Care of the Vehicle The policy requires you to keep your vehicle in a roadworthy and safe condition and with a valid MoT Certificate when required. You must take all reasonable precautions to avoid its loss or damage. You must always take the keys out of the ignition and remove them completely when the vehicle is left. You must close all windows and sun roofs and lock all doors. Alarms and immobilisers should be activated when fitted. (Your cover may be subject to Endorsements setting out additional requirements relating to immobilisers/alarms/tracking devices). Failure to take care of the vehicle, and comply with security requirements, will invalidate the insurance and may mean we will not pay any claim you make. Excess You have to make a contribution towards each claim you make and this may vary dependant on the age of the driver. The amount will be shown on the Schedule. Driving Abroad We provide the minimum insurance to allow you to use your vehicle in any member country of the EU and certain other countries. Unless you request an extension to your cover and you pay any additional premium required, the cover for use of the vehicle abroad is very restricted. It does not include loss or damage to the vehicle itself and may be very limited with regard to legal liability to others. No Claims Discount If you arrange an annual policy and you do not claim, and you, or anyone insured, has not been involved in an accident which may result in a claim, we will allow a discount from your renewal premium. Cancelling under the cooling off period We trust that the cover provided by this policy fully meets your needs. However, you do have the right to cancel the policy by returning your certificate of insurance to your insurance adviser or direct to Highway Insurance, along with your cancellation request, within 14 days of receiving the policy documentation. You will be charged a proportionate premium of the period of cover that you have enjoyed, subject to a minimum premium of 25 + Insurance Premium Tax. continued g

2 truck Insurance Proposal General (continued) Cancelling Your Insurance You may cancel the insurance at any time by telling us, or your insurance adviser, in writing or by or telephone and sending us your Certificate of Insurance. When we work out the time you have been covered we use the period from the date the insurance started to the date we receive your Certificate of Insurance. If you or someone else has not made a claim in the current period of insurance, we will refund part of your premium. Length of time you have had cover for Up to Up to Up to Up to Up to Up to Up to Up to Over 7 days 14 days 1 mth 2 mths 3 mths 4 mths 6 mths 8 mths 8 mths How much of the annual premium we will refund 85% 80% 75% 60% 50% 35% 25% 10% 0% Endorsement Your cover will be affected by any Endorsement(s) shown on the Schedule. These may add exclusions to the cover or require you to take action such as fitting approved security. Failure to comply with any Endorsement(s) may invalidate the Contract and mean we will not pay any claim you make. Physical or Mental Disabilities Where any driver suffers a disability, we will require confirmation of whether the DVLA/DVLNI has been advised and/or issued a restricted driving licence (whether by time or by the type of vehicle). A medical report or a copy of the driving licence may be required. Applicable law This Insurance is governed by English law (unless you live in Jersey or Guernsey, where Jersey or Guernsey law will apply). Third Party Cover Liability to others Unlimited cover in respect of your legal liability to others (including passengers) for death or injury. In addition legal liability for damage to property up to a maximum amount of 1,000,000 and for costs and expenses incurred up to a maximum amount of 5,000,000. Towing This includes your legal liabilities to third parties while your vehicle is legally towing a trailer or broken down vehicle. Legal representation At our option, and with our previous agreement, we will pay the fees for representation at a court of summary jurisdiction, fatal accident enquiry or coroners inquest and the reasonable costs of legal services we arrange for defending an insured person against a charge of manslaughter or causing death by dangerous driving. We may at any time discontinue such payments. Third Party Fire & Theft Third Party Cover - As above Fire and theft Loss or damage to your vehicle by fire or theft. If you do not remove the keys or leave the vehicle unlocked when it is left, or you fail to comply with the security requirements, we may refuse to pay any claim for theft. There is no cover for tools of trade, personal belongings, documents or goods. Comprehensive cover Third Party Cover - As above Vehicle damage Loss or damage to your vehicle.there is no cover for any vehicle being towed. There is no cover for any vehicle entertainment equipment, tools, personal belongings, documents or goods. Windscreen Damage Breakage or damage to the windscreen or windows up to the limit stated in the Schedule in any one period of insurance when replaced or repaired by Highway Glassline (telephone ) or up to 75 where any other supplier is used. An Excess applies to all claims unless the windscreen or window is repaired. Claims First Notification Any accident/loss/damage, regardless of fault and whether or not a claim will be made, must be personally notified to either our Contact Centre (GB) on or Contact Centre (Northern Ireland) on so that we can take the right action to protect your interests. Always obtain full particulars of all parties involved, passengers and other witnesses. Do not admit liability and do not do anything to harm our interest without our written permission. Send us immediately, unanswered, every letter you receive about a claim. Tell us as soon as you know about any prosecution, coroner s inquest or fatal accident enquiry. Dealing with claims We will pay the reasonable cost of protecting your vehicle and get an agent to take it to our nearest suitable repairer or other safe place if you cannot drive it. We will pay for your vehicle to be brought back to the address shown on the Schedule (but not for the cost of transport outside the United Kingdom unless we agree to do so first). You must pay the relevant Excess (and VAT if you are registered) to the repairer when you collect your vehicle or it is returned to you. We can take over and carry out the defence, prosecution, settlement or recovery of any claim(s) in your name or that of any other person insured, and have full discretion to deal with the claim as we see fit. You must give all information, documentation, help and cooperation required, including attending court to give evidence if necessary. Settlement At our option, we will pay for the damage to be repaired or give an amount to replace the lost or damaged vehicle or item or replace your vehicle or any item. The most we will pay, after deduction of the Excess, is the least of its market value or the cost of repairing it. Market Value The cost at the date of accident or loss of replacing the vehicle if possible with one of a similar make, model, age, condition or mileage. We will usually ask an engineer to give us advice about the Market Value of the vehicle, refer to Guides of vehicle values and any other relevant sources. Fraudulent, False, or Exaggerated Claims We will not pay a claim which is in any part fraudulent, false or exaggerated, or if you, or anyone acting for you, uses fraudulent or false means to pursue the claim. In such circumstances, we will cancel your policy and we will not return any premium.

3 truck Insurance Proposal Please complete all details in block capitals. (All questions must be answered in full. N/A and dashes are not acceptable). Where you see delete as applicable. Agency number Policy number 1 Proposer Full Name: Mr/Mrs/Miss (or Trading Name) Date of Birth / / What is your Operator Licence Number? It is a legal requirement that the operator of all vehicles that carry goods or burden, in connection with any trade or business including vehicles used for own goods only, with a plated weight of more than 3.5 tonnes or if unplated have an unladen weight of more than 1525kg must hold an Operators Licence. Address Post Code Marital Status Telephone Numbers Home Work Mobile Occupation Nature of Business VAT Registered VAT Reg No 2 Vehicle A separate policy will be issued for each vehicle. Vehicle make and type Type of body Gross veh. / train weight Who is the main driver Left hand drive Year of make Date of purchase Registration Present value (a) Are there any cosmetic mechanical or engine alterations to the vehicle from Manufacturers original specification? If Yes, give details. (b) Has the vehicle been fitted with any anti-theft device such as electronic alarm/immobiliser/tracking device? If Yes, give details. (c) (i) Are you the registered owner of the vehicle? (ii) Are you the registered keeper of the vehicle? (d ) Post Code of Operating Centre. (e) How many vehicles are owned and or used by you? (f) Is vehicle subject to Hire Purchase Agreement?

4 7 Have there been accidents, claims or losses (including fire and theft) whether to blame or not during the last three years in connection with every motor vehicle (including motorcycles) owned or driven by you or any person who to your knowledge will drive? If Yes, give dates, circumstances and total costs (including Third Parties) 8 Use In addition to Social Domestic and Pleasure use will the vehicle be used for: (a) Carriage of own goods within a radius of 100 miles from Operating Centre. (b) Carriage of own goods unrestricted radius. (c) Carriage of goods for hire or reward within 100 mile radius of Operating Centre. (d) Carriage of goods for hire or reward unrestricted radius. Is work on the continent undertaken? If Yes, state countries visited. 9 Goods carried (a) What kind of goods will normally be carried? (b) Will goods of an explosive, radioactive or dangerous nature be carried? If Yes, give details (c) Has any of the insured vehicle(s) a Haz Pak licence? If Yes, give details 10 Previous Insurance Have you ever been insured in respect of a motor vehicle? If Yes, state insurer and policy number. How many years no claims discount have you earned? Expiry Date / / Attach your proof of entitlement Is any other vehicle insured in your name? If Yes, give details 11 Has any Company or Underwriter declined a proposal or cancelled or refused to renew a motor insurance or required an increased premium or revised terms in respect of any motor insurance proposed or effected by or for you or any other person who to your knowledge will drive? If Yes, give details. 12 Time and date cover required : / / Indicate cover required (please tick) Comprehensive TPFT TPO Your Compulsory excess is 500. Do you want to increase your excess to 1,000? If Yes, please tick box 13 We would draw your attention to the Declaration below and in particular the importance of disclosing all information which might influence our acceptance and assessment of the Insurance. Is there any further information not asked in any other questions which would be of importance to Underwriters? If Yes, give details. warning When leaving your vehicle at any time ALWAYS close the doors, windows, sun roof and lock the vehicle removing the keys. Failure to do so may result in a claim for theft being refused. Don t make life easier for thieves, always remove the keys from your vehicle and lock it when you leave it, even temporarily. Not to do so may invalidate your cover so lock it or lose it!!!

5 3 Trailers (a) Please complete details of all trailers which you own. (Note that cover follows that of your towing vehicle) Vehicle make and type Serial number Present value NB: If detached cover is required such cover is restricted to premises owned or occupied by you or other contractors, provided such premises are declared, locked and secure. Trailers left for example in lay-bys, docks or car parks are T covered. (b) Is any vehicle or trailer fitted with a hoist or crane? If Yes, advise maximum lifting capacity. (c) Do you require cover on your trailer while detached from your tractor unit? (d) Do you hire or borrow trailers? (i) If Yes, do you require cover while detached from your vehicle but still in your custody or control? (ii) If Yes, state the maximum number of hired or borrowed trailers in your custody or control at any one time (iii) and state the maximum value of any trailer, hired or borrowed, for which you wish cover. (e) All trailers are kept at the following secure premises. 4 Drivers We will exclude drivers under 25 years of age, and drivers above this age who have held a full UK driving licence, applicable to the insured vehicle, for less than 12 months, unless such drivers have been disclosed to and agreed by us. Any driver who holds an EU licence that was issued outside the UK must also be disclosed to us. Give details of all persons likely to drive, INCLUDING YOURSELF. Drivers names Occupation Date of birth Type of current HGV licence held Date passed HGV test month/year Length of permanent and continual residence in UK Your details 5 Have you or any person who to your knowledge will ever drive been convicted of any offence including any fixed penalty in connection with any motor vehicle or any criminal conviction? Is any prosecution or police enquiry pending or have you been stopped by the police in the last six months? If Yes, give full details of offence codes, dates and penalties for motoring convictions or details of other offences (including fixed penalties). 6 Do you or does any person who to your knowledge will ever drive, suffer from any loss or loss of use of limb, eye, defective hearing or vision (not corrected by spectacles or hearing aids), a heart/diabetic/epileptic condition or from any other infirmity? If Yes, give details. (a) Date of onset of disability / / (b) Have you notified DVLA/DVLNI (c) Have DVLA/DVLNI issued a restricted licence? If Yes, attach copy licence

6 data protection act MUST BE READ Your policy details will be added to the Motor Insurance Database (MID) managed by the Motor Insurers Bureau (MIB). MID data may be used by certain statutory and authorised bodies including the Police, the DVLA, the DVANI, the Insurance Fraud Bureau and other bodies permitted by law for purposes including (but not limited to); electronic licensing; Continuous Insurance Enforcement; law enforcement; and the provision of government and/or other services aimed at reducing uninsured driving. If you are involved in a road traffic accident (either in the UK or abroad), insurers and/or the MIB may search the MID to obtain relevant information. Persons pursuing a claim in respect of a road traffic accident (including citizens of other countries) may also obtain relevant information from the MID. You must tell us about any incident (e.g. accident, fire or theft) whether or not a claim is likely to result. When you tell us about such an incident, information relating to it will be passed to the registers which we and others have in place which allow us to detect fraudulent applications and claims. We may search these databases when you apply for insurance, at renewal or in the event of an incident or claim. If you give us false or inaccurate information and/or make or attempt to make a fraudulent claim, this information will be recorded on the registers. All telephone calls relating to applications and claims may be monitored and recorded and the recordings used for fraud prevention and detection, training and quality control purposes. We and other organisations may also use and search these agencies and databases to help make decisions about the provision and administration of insurance and credit related services for you and members of your household. Also, to trace debtors, recover debt, prevent fraud, manage your accounts and insurance policies, check your identity to prevent money laundering, unless you furnish us with other satisfactory proof of identity, and undertake credit searches and additional fraud searches. The information you give us will be used by Highway Insurance Company Limited and we may share this information with other organisations to inform you by letter, telephone or of other products which may be of interest to you. If you do not wish to receive any marketing literature please write to our Customer Care Department. If you would like more information about this notice, please write to the Customer Care Department, Highway Insurance, 171 Kings Road, Brentwood, Essex, CM14 4EJ. customercare@highway-insurance.co.uk. Subject to the provisions of the Data Protection Act 1998, you are entitled, on payment of a small fee, to receive a copy of the information we hold about you. For more information on the Data Protection Act you may also write to the Office of the Information Commissioner at Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF. Telephone: declaration I declare that I have read the above questions and answers which have been completed accurately and fully by me or on my behalf with the information I have supplied. I confirm that I have read or had explained the Data Protection Notice and accept the terms contained in it. I confirm the Notice will be made known to any party related to the insurance. I undertake that the Vehicle(s) described shall not be driven by any person who to my/our knowledge has been refused any Motor Vehicle Insurance or has had insurance cover cancelled. I declare that the statements and particulars above are to the best of my knowledge and belief, true, that the Vehicle(s) described is my property and in roadworthy condition and that no information has been withheld by me that might influence Highway s acceptance and assessment of this Insurance (and failure to provide such information may result in any claim not being paid). I agree that this Proposal signed or caused to be signed by me shall form part of the contract between me and Highway Insurance. Date / / Signature of Proposer Print Name Position in Company LV= and Liverpool Victoria are registered trade marks of Liverpool Victoria Friendly Society Limited and LV= and LV= Liverpool Victoria are trading styles of the Liverpool Victoria Group of companies. Underwritten by Highway Insurance Company Limited, part of the Liverpool Victoria group of companies. Highway Insurance Company Limited, registered in England and Wales number is authorised and regulated by the Financial Services Authority, register number Registered address for both companies: County Gates, Bournemouth BH1 2NF. LV=