Proposal Form Commercial Vehicle

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1 Commercial Vehicle for your commercial vehicle insurance

2 Introduction About NIG Thank you for choosing NIG as your Commercial Vehicle insurer. We have been established for over 100 years and provide insurance products to over 2 million customers across the UK. Operating from its London Head Office and network of regional offices NIG sells its policies through over 2,500 professional intermediaries at over 5,000 retail locations. NIG conducts its business from the United Kingdom and is a part of The Royal Bank of Scotland Group, currently the second largest bank in Europe and fifth largest in the world. Visit for further details. About Finsure Finsure is an award winning premium finance company and is a subsidiary of NIG. It enables customers to spread the cost of their insurance over a year in easy to pay instalments. Finsure provides customers with a high level of service with staff who have an excellent understanding of insurance. Choice of Cover Third Party Fire and Theft You are covered for liability to third parties (including passengers) in respect of compensation for injury or damage, legal costs and emergency treatment. Cover for Third Party property damage is limited to 1,000,000 for any one accident. Plus loss of or damage to your vehicle caused by fire, theft or attempted theft. An excess applies. Comprehensive Cover as Third Party Fire and Theft plus loss of, or damage, to your vehicle. An excess applies. Windscreen Cover This extension is automatically included on all Comprehensive policies. You will be responsible for the first part of any claim under this section when the windscreen is replaced and not simply repaired. Your Claim Bonus is not affected by windscreen claims. Audio/Telecommunication Equipment Cover for this equipment is limited dependent on policy cover. Please consult your Insurance Adviser for full details of policy cover, benefits and excesses. Trailers Third Party only cover is automatically given while you are towing a trailer attached to your vehicle. If you require the trailer itself to be insured, we offer damage and fire and theft cover at a small additional premium. We will require to known the make of the trailer, the serial number, and its value. Description of Use Only for carriage of your own goods including towing a trailer. Use for Social, Domestic and Pleasure purposes and in connection with your business including the carriage of your own goods and while towing a trailer. Excluding use for the carriage of goods or passengers for hire or reward, renting out, racing, pacemaking, speed testing, rallies, trials, competitions or use on any motor sport circuit. Cancellation If the cover does not meet your requirements, please return all your documents (including the certificate) to your broker or intermediary within 14 days of receipt. We will return any premium paid less a pro rata charge for the number of days for which cover has been given. The full annual premium is due if a total loss claim has been made. Insurance Adviser 1 Commercial Vehicle

3 Commercial Vehicle Proposal Form It is recommended that you keep a record of all information supplied, (including copies of letters) for the purpose of entering into this contract. You may also apply for a copy of this form within the next three months. A specimen copy of the policy is available on request which gives details of the Company s complaints procedure. The Company reserves the right to decline any proposal submitted. The Law of England and Wales applies to this policy. Insurance Adviser Use Only Agency number Broker ref. number Premium Calculation & NCB Quote ref. A Period of Insurance 12 months from until B Your Information For details of how we will use your information and how to give your consent, please look for the padlock symbol - page 6 and in the accompanying terms and conditions. C You the Proposer Mr/Mrs/Ms/Miss or Title Telephone number: home First name(s) Telephone number: work Surname or Company Name Telephone number: mobile Occupation Home or Business address Postcode Have you had a County Court judgement registered against you in the past six years or defaulted on any credit agreement (including loans)? If yes, give details (including date & amount) note, you must include any judgements which were subsequently satisfied. Commercial Vehicle 2

4 D Your Vehicle This policy is only for Commercial vehicles used for carrying your own goods (see over for description of use) Make and Precise Model Type of Body and Date of Purchase Gross vehicle weight Maximum carrying Engine Cubic Year of Make number. of seats (max 3.5 tonne gvw) capacity (incl trailer) Capacity Value (inc. valuables) Present Mileage Expected Yearly Mileage Colour Registration Tick appropriate box: a Is the vehicle normally kept overnight: in a locked garage? 1 in a locked compound? 2 un-garaged on your property? 3 on the road? 4 b Is the vehicle normally kept overnight at the above address? If no, give address and postcode c Is the vehicle left-hand drive? d Has the vehicle been altered in any way including electronically, e.g. engine or body modifications, special or non-standard equipment, nonstandard wheels? If yes, give details e Has the vehicle been fitted with any security or tracking devices? If yes, give details including make and model number f Who owns the vehicle? Tick appropriate box: You 1 Your spouse/civil partner 2 A firm/leasing company 3 Other 4 If 3 or 4 is ticked give details g Is the vehicle registered in your name? If no, give details 3 Commercial Vehicle

5 E Cover See Choice of Cover for description and requirements if a trailer is towed Tick cover required Comprehensive (including windscreen cover) 1 Protected Bonus policy required Voluntary Excess (Comprehensive policies only) 50, 100, 200, 300, 400 or 500 (Enter level) Third Party Fire and Theft 2 Will you tow a trailer? F Details of Persons who will Drive your Vehicle Drivers under 25 years of age will be excluded unless disclosed Tick appropriate box You only 1 You and your spouse 2 You and your civil partner 3 You and named drivers 4 Please give details of yourself, all employees, and all other persons who may drive (Full information is required, ticks and dashes are not acceptable). 1 Yourself Nature of business Driver Sex Date of Age Employment status e.g. Bank, Factory, Hospital Precise occupation (Give full Name) M/F birth e.g. Employed,Self Employed, Unemployed, Retired (give previous if Unemployed) (e.g. Clerk, Engineer, Nurse) If there is an additional or part-time job give detail of both 1 Yourself 2 As above 3 As above 4 As above Type of current U.K. car licence; How long Does this driver have use of any other vehicle? Driver full, provisional or triennial and period held. resident in Type Years Months U.K.? / If yes give owner or state if company car a Do you or any person who may drive the vehicle have any criminal convictions (or been charged with a criminal offence but not yet tried)? c Have there been any accidents, thefts or losses (whether covered by insurance or not and regardless of blame) during the past 3 years in connection with any vehicle owned, driven, or insured by or in the charge of you or any person who to your knowledge may drive? b Have you or any person who may drive had any motoring convictions during the last 5 years or are there any prosecutions pending or police enquiries outstanding (including fixed penalty offences)? If a, b or c have been answered yes give the following details: Name Date of Offence Fines Disqualification Date of accidents/ Brief description of circumstances Cost of Were all costs Convictions Codes Periods thefts/losses claims recovered? Commercial Vehicle 4

6 F Details of Persons who will Drive your Vehicle - continued d Do you or does any person who may drive have defective vision or hearing (not corrected by glasses or hearing aid) any physical, mental, alcoholic or nervous disorder, or heart, diabetic or epileptic condition or other complaint, had blackouts or fits or regularly take any prescribed medication? If yes, give details including name(s) of persons, nature of complaints, years stabilised if appropriate and details of medication. Also confirm that DVLA have been informed and advise whether your/their driving licence is restricted as a result. 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 or mental condition) which affects or may become likely to affect their fitness as a driver. G Insurance History a How long have you owned a motor vehicle, including motor cars? d Has any insurer at any time in respect of motor insurance declined to insure you or any person who may drive, avoided or cancelled your or their policy, or refused to renew? b State name of previous insurer and policy number ( Claim Bonus must not be currently used on another vehicle) If yes, please give details c What type of vehicle was insured under that policy? H Credit Scheme If you are eligible would you like to apply for credit and utilise our monthly payment scheme If yes, please read the section headed Payment by Instalments and then complete the Direct Debiting instruction on page 8. Minimum Premium Commercial Vehicle

7 I Declaration and Signature The proposer must read and complete this section. Important te You are reminded that it is essential you provide all material information likely to influence the acceptance and assessment of this insurance. If you have any doubts as to whether a fact is material it should be disclosed. Failure to disclose any material facts may invalidate your policy or may result in your policy not operating fully. It is an offence under the Road Traffic Acts to make any false statement or withhold any material information for the purposes of obtaining a certificate of motor insurance. Your Information Your Insurer You are giving your information to NIG who is a member of The Royal Bank of Scotland Group (The Group) For information about our Group of companies please visit and click on About Us, or for similar enquiries please telephone or Textphone Your electronic information If you contact us electronically, we may collect your electronic identifier e.g. Internet Protocol (IP) address or telephone number supplied by your service provider. How we use your information and who we share it with. We will use your information to manage your insurance policy, including underwriting and claims handling. This may include disclosing it to other insurers, third party underwriters and reinsurers. Your information includes data about your transactions. We may use and share your information with other members of the Group to help us and them: assess financial and insurance risks; recover debt; prevent and detect crime; develop services and systems. We do not disclose your information to anyone outside the Group except: where we have your permission; or where we are required or permitted to do so by law; or to other companies who provide a service to us or you; or where we may transfer rights and obligations under this agreement. We may transfer your information to other countries. If we do this we will ensure that anyone to whom we pass it provides an adequate level of protection. We are also required to supply motor insurance policy details to the Motor Insurance Database (MID) run by the Motor Insurers Information Centre (MIIC) to which the Police, DVLA/DVLNI (Driver and Vehicle Licensing Agencies) and other insurers have access. Law enforcement agencies may access and use this information. Sensitive Information Some of the personal information we ask you for may be sensitive personal data, as defined by the Data Protection Act 1998 (such as information about health or criminal convictions) We will not use such sensitive personal data about you or others except for the specific purpose for which you provide it and to provide the services described in your policy documents. Please ensure that you only provide us with sensitive information about other people with their agreement. Fraud prevention agencies If false or inaccurate information is provided and fraud is identified or suspected, details may be passed to fraud prevention agencies. We and other organisations may also access and use this information to prevent fraud and money laundering, for example when: checking applications for, and managing credit and other facilities and recovering debt; checking insurance proposals, Statement of Facts and claims; checking details of job applicants and employees. We, and other organisations that may access and use information recorded by fraud prevention agencies, may do so from other countries. We can provide the names and addresses of the agencies we use if you would like a copy of your information held by them. Please contact us at NIG Crown House 145 City Road, London EC1V 1LP. The agencies may charge a fee. If you would like a copy of the information we hold about you, either telephone or write to us at NIG, 9 Geneva Street, Peterborough, PE1 2RW and ask for a Subject Access Request Form (SAR). Alternatively, you may download a Subject Access Request Form from our internet site at I agree that if any answer has been printed or written by any other person, he/she shall be my agent for that purpose. I also confirm that any data which I have supplied in this Form about other persons is given with their knowledge and authorisation. Commercial Vehicle 6

8 I Declaration and Signature - continued Declaration I declare that to the best of my knowledge and belief the information given in this Form is correct and complete in every detail. I understand that you will pass the information on this form and about any incident I may give details of to the MID, fraud prevention agencies and other members of the group. I also understand that, if you make any searches in connection with this application or any incident of which I provide details, you may also accept and process any information from the fraud prevention agencies which has been received from other insurers concerning other incidents in which any person covered under this policy may be involved. Giving your Consent. By signing the accompanying credit agreement you are agreeing that we may use your information in the way described in this form and in associated terms and conditions. Proposer s Signature Date J Payment by Instalments If you qualify for credit facilities we ask for a deposit of 20% of the annual premium and spread the balance plus a small credit charge into 10 equal instalments starting the first month after cover commences. You will be notified by letter of the premium, charge for credit, (please note that any change to the percentage charge will not be effected until renewal of this policy) and repayment details prior to the withdrawal of the first instalment. In the event of there being a delay in collecting the first withdrawal it will include all instalments due up to that date. For example: Annual Premium (incl IPT) Minimum Premium 100 less Deposit Amount of Credit Payable by 10 monthly instalments of 8.80 plus Credit Charge of 10% 8.00 Total Outstanding Total Amount Payable APR = 23.5% Any changes to the premium during the year will be dealt with by adjusting the monthly instalments. At least 14 days before renewal you will receive a renewal letter with all the financial details, including the new monthly instalments, which will be collected over 12 months. For cover to continue, no action is required by you in connection with payment. However, if you do not wish to renew, please tell your insurance adviser. In this event you should cancel the direct debiting instruction with your bank in connection with payment prior to your renewal date. Full terms and conditions will be sent to you prior to collection of the first instalment but a summary of the main terms is provided overleaf. The Direct Debit Guarantee 1 This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the Scheme is monitored and protected by your own Bank/Building Society. 2 If the amounts to be paid or the payment dates change, Finsure will notify you 7 days in advance of your account being debited or as otherwise agreed. 3 If an error is made by Finsure or your Bank/Building Society, you are guaranteed a full and immediate refund of the amount paid from your branch. 4 You can cancel a Direct Debit at any time, by writing to your Bank/Building Society. Please also send a copy of your letter to us. Main Terms and Conditions 1 In the first year the premium is paid by a deposit of 20% of the annual premium and 10 monthly instalments. 2 The first instalment is due 1 month after the policy commences, with future instalments due monthly on or around the same date. 3 The dates and amounts of your monthly instalments will be sent to you by post at least 7 days before the first instalment. 4 If there is any delay in collecting the first instalment, when it is collected all payments due will be collected together at that time - please make provisions for this. 5 The policy is an annual contract. Following a claim, total loss settlement or disallowance of a Claim Bonus, any balance of the premium outstanding must be paid in full and we reserve the right to deduct any arrears from the claims settlement. 6 Should the policy be cancelled mid-term then we shall require the return of the annual Certificate(s) of Insurance. If this is not returned then the full annual premium will be due and we will take all reasonable steps to recover any remaining debt. 7 Commercial Vehicle

9 K Direct Debit Form Please fill in the whole form and send it to your Insurance Adviser I wish to pay my insurance premium by instalments Name in full (BLOCK CAPS) Broker/Intermediary use only Agency Proposer s/policyholder s Signature Date Policy Instruction to your Bank or Building Society to pay direct debit 1 Name(s) of account holder(s) Originators Identification Number Bank or Building Society account number 2 Name and full postal address of your Bank or Building Society branch To: The Manager Address Postcode Bank or Building Society 3 Branch sort code (from the top right hand corner of your cheque) 5 Finsure Premium Finance reference number (office use only) 6 Instruction to your Bank or Building Society Please pay Finsure Premium Finance Ltd Direct Debits from the account detailed on this Instruction subject to the safeguards assured by The Direct Debit Guarantee. Signature(s) Date acknowledgement required Banks and Building Societies may not accept Direct Debit Instructions for some types of account. I understand that this Instruction may remain with the originator Finsure and details may be passed to my Bank/Building Society electronically. Commercial Vehicle 8

10 L Additional Information Please enter additional information and material facts here. 9 Commercial Vehicle

11 L Additional Information Please enter additional information and material facts here. Commercial Vehicle 10

12 NIG is the trading name of The National Insurance and Guarantee Corporation Limited. Registered Office: Crown House, 145 City Road, London EC1V 1LP. Registered in England & Wales number NIG is authorised and regulated by the Financial Services Authority. Our FSA register number is Our permitted business is selling and administering contracts of general insurance. 4560K/06/07

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