Ventnor Haven Fishery Address

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1 Commercial Vehicle Agency Number: xml106 Statement of Fact Broker Reference: PLEASE READ CAREFULLY Please read the following information carefully. It is a record of statements made and information given by you and your insurance policy will be based on the information you have given us. WARNING: In entering into this contract of insurance you must take all reasonable care in answering all questions in relation to this insurance honestly and to the best of your knowledge. Your failure to take reasonable care in avoiding misrepresentation in relation to the information provided could result in your policy being cancelled or your claim being rejected or not fully paid. You should keep a complete record (including copies of all letters) of all information supplied to the Company for the purpose of entering into this contract of insurance If you are satisfied that, to the best of your knowledge, this is a true statement of the facts you need take no further action, simply retain the form in a safe place along with your policy and Certificate of Insurance. If any of the following details appear to be incomplete or incorrect please contact your Broker within the next seven days. Failure to do so could invalidate your insurance. You will be advised of any changes in the premium or terms and a revised Statement will be issued to you. YOUR DETAILS Name Ventnor Haven Fishery Address Ventnor Haven Fishery Esplanade, Ventnor PO38 1JR Garage Postcode (If different): PO38 1RF Telephone : Day Evening VEHICLE DETAILS Make and Model Toyota Hilux Invincible D/Cab D-4d Year first registered 11 Purchased on or before 13/02/2013 Engine C.C Right or left hand drive Right Registration number KW11UKC Type of Body Van. of Seats 2 Gross Vehicle Weight 3.10 Carrying Capacity 1.10 Your Valuation (Incl. Accessories) Registered Owner/Keeper Proposer Is the vehicle fitted with a security device? Where is it kept overnight? Off Road Estimated annual mileage Is the vehicle signwritten? Number of Months Trading 60 How many commercial vehicles does the proposer own? 4 Do you carry Hazardous or dangerous goods? Has the vehicle been modified from the manufacturers specification in any way, this includes Signwritten? If yes, please give details ABOUT YOUR COVER Period of cover From 08/06/2016 To Permitted use Carriage of Own Goods Windscreen Excess Cover type Comprehensive Voluntary excess 0 Please refer to your Certificate of Motor Insurance and Policy Schedule for excesses applying to your Policy. The sum you must pay towards the cost of any damage. Other Policy Excesses may apply. See Policy Booklet for further details. ABOUT YOUR DRIVING EXPERIENCE Your premium incorporates 9 ( t Proven ) Claims Discount ( t Protected ) from your previous policy. Zenith Insurance plc, Authorised Insurers, registered in Gibraltar ( ) with registered office address at Europort, Gibraltar.

2 ABOUT THE DRIVERS OF YOUR VEHICLE Who will the vehicle be driven by? Named Drivers Driving by: Proposer Driver 1 Driver 2 Driver 3 Driver 4 Full Name Mr Geoffrey Blake Mr Edward Blake Date of Birth Age Marital status Married Single Relationship Main Driver? Yes Occupation Fish Merchant Fish Merchant Employers business Fish Merchants Fish Merchants Part Time Occupation Part Time Employers business Type of Driving Licence Full UK Full UK How long held 21 4 Does the driver have use of another vehicle? N/A Has the driver been resident in the UK for the last 3 years? Yes Life Have you or any person who may drive ever been involved in any accident or suffered any loss (whether to blame or not) or theft involving a motor vehicle - whether or not the subject of a claim in the last five years? (Given details) Date Description Cost/Fine ( ) Driver n-fault Accident 0 Mr Geoffrey Blake Fault Accident Mr Geoffrey Blake Have you or any person who may drive, been convicted of (or been warned that for a recent offence is being considered) any motoring offences (including fixed penalty offence) or received a licence endorsement during the last 5 years? Ever been disqualified from driving? (Given details) Date Description Points Cost/Fine ( ) Ban Driver Have you or any person who may drive ever suffered from any physical or mental condition which must be notified to the DVLA? Have you or any person who may drive at any time had special terms or conditions imposed by and insurer or had a policy cancelled or a proposal declined or a renewal refused by an insurer? COMPANY UNDERWRITING THIS INSURANCE Authorised Insurer: Zenith Insurance plc This statement was issued on: 19th May 2016 Zenith Insurance plc, Authorised Insurers, registered in Gibraltar ( ) with registered office address at Europort, Gibraltar. limited regulation by the Financial Conduct Authority in respect of underwriting business in the UK ( ). Pfzcv-cv-sof.rtf _01 Page 2 of 5

3 ADDITIONAL DRIVERS DETAILS Driving by: Driver 5 Driver 6 Driver 7 Driver 8 Driver 9 Full Name Date of Birth Age Marital status Relationship Main Driver? Occupation Employers business Part Time Occupation Part Time Employers business Type of Driving Licence How long held Does the driver have use of another vehicle? Has the driver been resident in the UK for the last 3 years? Have you or any person who may drive ever been involved in any accident or suffered any loss (whether to blame or not) or theft involving a motor vehicle - whether or not the subject of a claim in the last five years? (Given details) Date Description Cost/Fine ( ) Driver Have you or any person who may drive, been convicted of (or been warned that for a recent offence is being considered) any motoring offences (including fixed penalty offence) or received a licence endorsement during the last 5 years? Ever been disqualified from driving? (Given details) Date Description Points Cost/Fine ( ) Ban Driver Please enter any further details in the box provided below: We are assuming for the purpose of this quotation, the following information: The Proposer or any Person named on this policy has never been convicted of or charged (but not yet tried) with any offence other than driving offences, been the subject of a County Court Judgement (or Scottish equivalent), been declared bankrupt or a subject to bankruptcy proceedings, any voluntary or mandatory insolvency, ever been declined or refused insurance cover or had cover cancelled or subject to special terms in respect of any covers to which the insurance relates, ever been subject of a recovery action by customs and excise or the inland revenue, with the past 5 years been prosecuted or serviced prohibition or improvement order under health and safety legislation. Zenith Insurance plc, Authorised Insurers, registered in Gibraltar ( ) with registered office address at Europort, Gibraltar. limited regulation by the Financial Conduct Authority in respect of underwriting business in the UK ( ). Pfzcv-cv-sof.rtf _01 Page 3 of 5

4 NOTES CONCERNING THIS APPLICATION FOR INSURANCE 1. liability (except for the period stated on our official Cover te) is undertaken until the application is accepted by ourselves and the premium paid. 2. We reserve the right to ask for special terms or decline this application. If we decline this application a premium will be payable by you for the period in the official Cover te. 3. You should keep a record (including copies of letters) of all information supplied for the purpose of entering into this insurance. 4. We will supply a copy of this Statement of Fact on request within three months of completion. 5. For our joint protection, telephone calls may be recorded and/or monitored. 6. A Specimen copy of the policy is available upon request. 7. The cancellation procedure, complaints procedure and a summary of the policy terms and conditions are contained in the separate Policy Summary document, a copy of which is available from your insurance intermediary. NOTICE - DATA PROTECTION - you should show this notice to any other party related to this insurance. We are governed by the Data Protection legislation applicable both in the United Kingdom and Gibraltar. Under this legislation we are required to tell you the following information. It explains how we may use your details and tells you about the systems we have in place that allow us to detect and prevent fraudulent applications and claims. The savings that we make help us to keep premiums and products competitive. For the purpose of the relevant legislation, the Data Controller in relation to any personal data you supply is Zenith Insurance Management UK Limited on behalf of Zenith Insurance Plc. We may store your information on a computer and in certain circumstances we may have to transfer your information to another country but we will not pass information to any country outside of the EEA (European Economic Area). By proceeding with your insurance application we will assume you agree to this. INSURANCE ADMINISTRATION Information you supply may be used for the purposes of insurance administration by the insurer and its agent, by re-insurers and your intermediary. In assessing any claims made, insurers may undertake checks against publicly available information such as electoral roll, county court judgement, bankruptcy or repossessions. Information may also be shared with other insurers either directly or via those acting for the insurer such as loss adjusters or investigators. INFORMATION ON PRODUCTS & SERVICES Zenith Insurance Plc is a member company of the Markerstudy Group. We may use your details to send you information about other products and services from companies within Markerstudy Group or to carry out research. We may contact you by letter, telephone or . Please be reassured that we won t make your personal details available to any companies outside Markerstudy Group to use for their own marketing purposes. If you would prefer not to receive information from companies within the group or participate in research, simply write to Data Protection Officer, Zenith Insurance Management UK Limited, Chester House, Harlands Road, Haywards Heath, West Sussex, RH16 1LR. EXCHANGING INFORMATION WITH OTHER INSURERS Insurers pass information to the Claims and Underwriting Exchange register, run by Insurance Database Services Ltd (IDS Ltd). The aim is to help us to check information provided and also to prevent fraudulent claims. When we deal with your request for insurance, we may search the register. When you tell us about an incident (such as a fire, water damage or theft) which may or may not give rise to a claim, we will pass information relating to it to the register. You can ask us for more information about this. MOTOR INSURANCE DATA BASE Information relating to your insurance policy will be added to the Motor Insurance Database ("MID") managed by the Motor Insurers Bureau ("MIB"). MID and the data stored on it may be used by certain statutory and/or authorised bodies including the Police, the DVLA, the DVLNI, the Insurance Fraud Bureau and other bodies permitted by law for purposes not limited to but including : I. Electronic Licensing II. Continuous Insurance Enforcement; III. Law enforcement (prevention, detection, apprehension and or prosecution of offenders) IV. The provision of government services and or other services aimed at reducing the level and incidence of uninsured driving. If you are involved in a road traffic accident (either in the UK, the EEA or certain other territories), insurers and or the MIB may search the MID to obtain relevant information. Persons (including his or her appointed representatives) pursuing a claim in respect of a road traffic accident (including citizens of other countries) may also obtain relevant information which is held on the MID. It is vital that the MID holds your correct registration number. If it is incorrectly shown on the MID you are at risk of having your vehicle seized by the Police. You can check that your correct registration number details are shown on the MID at FRAUD PREVENTION, DETECTION & CLAIMS HISTORY In order to prevent and detect fraud we may at any time: Share information about you with the police, fraud prevention agencies and databases, and if you give us false or inaccurate information and we suspect fraud, we will record this. We and other organisations may also search these agencies and databases to: - Help make decisions about the provision and administration of insurance, credit and related services for you and members of your household; - Trace debtors or beneficiaries, recover debt, prevent fraud and to manage your accounts or insurance policies; - Check your identity to prevent money laundering, unless you furnish us with other satisfactory proof of identity; Undertake credit searches and additional fraud searches (this may include requests for copy driving licences, utility bills and other documentation to establish the identity of any person applying for insurance). We can supply on request further details of the databases we access or contribute to. CLAIMS HISTORY Under the conditions of your policy you must tell us about any Insurance related incidents (such as fire, water damage, theft or an accident) whether or not they give rise to a claim. When you tell us about an incident we will pass information relating to it to a database. We may search these databases when you apply for insurance, in the event of any incident or claim, or at time of renewal to validate your claims history or that of any other person or property likely to be involved in the policy or claim. On payment of a small fee you are entitled to receive a copy of the information we hold about you. If you have any questions, or you d like to find out more about this notice you can write to the Data Protection Officer at Zenith Insurance Management UK Limited, Chester House, Harlands Road, Haywards Heath, West Sussex, RH16 1LR CREDIT SEARCHES AND ACCOUNTING In assessing your application/renewal, we may search files made available to us by credit reference agencies. They keep a record of that search. We may also pass to credit reference agencies information we hold about you and your payment record with us. Credit reference agencies share information with other organisations, enabling applications for financial products to be assessed or to assist the tracing of debtors, or to prevent fraud. We may ask credit reference agencies to provide a credit scoring computation. Credit scoring uses a number of factors to work out risks involved in any application. A score is given to each factor and a total score obtained. Where automatic credit scoring computations are used by us, acceptance or rejection of your application will not depend only on the results of the credit scoring process. SENSITIVE DATA In order to assess the terms of the insurance contract or administer claims which arise, we will need to collect data which the Data Protection Act defines as sensitive such as medical history or criminal convictions. By proceeding with this contract you will signify your consent to such information being processed by the insurer or its agents. Zenith Insurance plc, Authorised Insurers, registered in Gibraltar ( ) with registered office address at Europort, Gibraltar. limited regulation by the Financial Conduct Authority in respect of underwriting business in the UK ( ). Pfzcv-cv-sof.rtf _01 Page 4 of 5

5 How do I make a complaint about my Zenith Policy? We aim to provide a first class service to all our Policyholders, however occasionally an enquiry or a complaint may arise which will usually be resolved quickly and efficiently to our Policyholders satisfaction. If you have an enquiry or cause to make a complaint regarding your policy please contact: - Zenith Customer Relations, PO Box 730, Chesterfield, S40 9LL Tel: complaints@zenith-insurance.co.uk We will always confirm receipt of your complaint within five working days and do our best to resolve the problem within four weeks. If we are unable to do so, we will let you know when the answer may be expected. Depending on the nature of your complaint, you may need to contact the broker/agent who arranged the Insurance for you. In the event your complaint is about Policyfast, please contact: - Operations Manager Policyfast Limited Unit 5 Vantage Park Washingley Road Huntingdon PE29 6SR Ifyou remain dissatisfied with the way in which your complaint has been handled, you may be able to refer the matter to the Financial Ombudsman Service at: - The Financial Ombudsman Service South Quay Plaza 183 Marsh Wall London E14 9SR Tel: DECLARATION AND NOTES By accepting this Statement of Fact as a true and complete record of the information relevant to this application for insurance you confirm that: (a) (b) (c) you have taken all reasonable care in answering all questions on this Statement of Fact honestly and to the best of your knowledge, and you understand that if any questions have not been answered honestly and correctly this may mean that your policy could be cancelled and/or your claim rejected or not paid in full, and if the information shown on this Statement of Fact has been provided by any person other than you, such person shall be deemed to be your agent for the purpose of providing such information. You agree to accept a policy booklet in the current form issued by the insurers subject to the terms and conditions and limitations contained therein and you agree to pay the premium. You understand that we will pass the information on this form and about any incident you may give details of to IDS Ltd and the ABI so that they can make it available to other insurers. You also understand and accept that, in response to any searches we may make in connection with this application or any incident you have given details of, IDS Ltd and the ABI may pass us information it has received from other insurers about other incidents anyone insured to drive the vehicles covered under the policy has been involved in. You agree that the contract shall be subject to English Law. Zenith Insurance plc, Authorised Insurers, registered in Gibraltar ( ) with registered office address at Europort, Gibraltar. limited regulation by the Financial Conduct Authority in respect of underwriting business in the UK ( ). Pfzcv-cv-sof.rtf _01 Page 5 of 5