Motor Fleet Fctfinder Motor Fleet Fctfinder Hulge ANTHONY JONES INSURANCE BROKERS Importnt: The informtion you give on this form is is relevnt to to our our ssessment of of the the insurnce risk risk t t new new usiness quottion stge or on renewl. Filure to provide complete nd ccurte nswers my entitle us us to to vry vry or or void ny ny insurnce cover cover susequently issued. The im of ll fleet opertors hs to to e e to to mximise sfety, security nd nd efficiency of of stff, customers, lods crried nd other rod users. The more effectively risk mngement mesures re pplied the the greter the the chnces of of minimising future clims numers nd costs, (which is the determining fctor in in controlling insurnce expenditure), plus plus those those dditionl costs orn y yourself when your vehicle is is temporrily removed removed from from use. use. Upon Upon receipt receipt of of this this form form your we insurers my suggest my suggest some res some you res should you should give ttention give ttention to further to further enhnce enhnce your your risk mngement risk mngement progrmme. progrmme. To ssist fleet opertors we hve developed the Rodsense product, supported y the wesite www.viv.co.uk/rodsense It contins prcticl tools nd informtion for Fleet Mngers. Compny Nme Compny Wesite Address Policy Numer Renewl Dte 1 Generl () Plese indicte the totl numer of vehicles within your fleet. Typicl Annul Milege Privte Crs essentil usiness use. Privte Crs others. Goods Crrying Vehicles to 3.5t GPW. (iv) Goods Crrying Vehicles over 3.5t - 16t GPW. (v) (vi) Goods Crrying Vehicles over 16t - 32t GPW. Goods Crrying Vehicles over 32t GPW. (vii) All other vehicles. (vii) The mximum numer of trilers in your possession t ny one time. (ix) Are ny vehicles vlued over 15,? If plese give detils (registrtion numer & vlue). () Plese provide detils of ll temporry dditionl vehicles tht hve een in your custody or control during the current period of insurnce. Vehicle Detils Dte Acquired Dte Returned Plese ttch seprte sheet giving detils of ny dditionl temporry vehicles during the current period. Cn you estimte the numer of dys of temporry vehicles likely to e in your custody or control for the coming period. 1
(c) Plese indicte the nture of your opertion (generl hulge, groupge, ulk hulge, logistics etc). Hve these chnged in the lst 12 months? Do you nticipte ny chnge in the next 12 months? If plese give detils. (d) Do you undertke ny time-criticl or multi drop opertions? If plese give detils (e.g. numer of vehicles, numer of dily drops, urn deliveries). Plese indicte: (iv) The type of Opertors licence held (Restricted, Stndrd Ntionl, Stndrd Interntionl). Licence numer(s). Numer of vehicles on ech licence. Numer of trilers on ech licence. (f) (g) How mny Operting Centres do you hve? Plese provide detils of ny licence offences or prohiitions you hve incurred (e.g. mintennce, vehicle, tchogrph etc) in the lst 12 months. (h) If known, plese give your current Opertor Complince Risk Score: Rodworthiness. Trffic Enforcement. Note: Opertor Complince Risk Scores re ssessed y VOSA nd re ville on enquiry. Hve you significntly ltered the vehicle profile during the pst 2 yers (e.g. preference of higher weight vehicles, extended replcement periods etc)? If plese give detils. (j) Do you intend, or hve you plnned to introduce ny chnges in the immedite future? If plese give detils. 2 Drivers () Plese dvise the numer of employed drivers. Full time. Prt time. () Approximtely wht percentge of regulr compny vehicle drivers re: 24 or under. 25 to 29. 3 or over. 2
(c) Plese indicte the level of turnover of driving stff during the pst 12 months. (d) Are your drivers slried? Do you operte performnce onus scheme? If plese give detils. (f) Do you use Agency drivers? If : If yes, plese give detils of the numer of Agencies used nd numer of driver dys per yer. How do you choose your Agencies? Do you give Agency Drivers ny induction trining or competency checks? If plese give detils. (g) Do you employ non-uk drivers? If plese give detils (ntionlity of the drivers nd the percentge of drivers from ech country). (h) Plese provide detils of ny serious motoring convictions incurred y ny drivers in the pst 3 yers. (Serious mens ny conviction(s) resulting in disqulifiction, ny conviction relting to Drink, Drugs, Dngerous Driving or Creless Driving cusing deth). Driver Conviction Code Dte Sentence Blood Alcohol Level (if pplicle) 3 Driver Mngement () For ll new employees who will drive on usiness, do you: Hve completed ppliction form? If plese provide copy. Tke copy of their driving licence? Otin detils of ny previous motoring ccidents or convictions? (iv) Alwys follow up references? (v) Assess their driving ility? If plese indicte who conducts this. (vi) Provide induction trining? If plese give detils. () How often do you check driving licences? (c) Do you issue drivers with compny driver hndook? If plese provide copy. 3
(d) Do you record nd nlyse incidents? Do you give drivers instructions in the event of n ccident? If plese give detils. (f) Does mnger interview the driver following n ccident? (g) Do you operte penlty/incentive scheme to encourge ccident free driving? If how long hs this een in opertion? Plese provide detils. (h) Do you llow non-employees to drive your compny crs? If do you: Tke copy of their driving licences? Otin detils of ny previous motoring ccidents or convictions? 4 Driver Trining () Do you hve n in-house driver ssessor/triner? If plese give detils (nme & qulifictions). () Are you currently involved in n externl driver-trining progrmme? If : Which driver trining orgnistion do you use? Plese give rief detils of the progrmme. How mny drivers hve undertken externl driver trining during the lst: 12 months. 24 months. 5 Vehicles () How is vehicle mintennce crried out? In-house. Contrcted out. () Do you fit security devices (other thn mnufcturers stndrd system)? Thtchm-pproved lrms/immoilisers. No. of vehicles fitted: Non Thtchm-pproved lrms/immoilisers. No. of vehicles fitted: Remote trcking devices. No. of vehicles fitted: (iv) Telemtics systems. No. of vehicles fitted: Plese indicte which systems you instll. Plese dvise the dte the systems were instlled. (c) Wht dditionl steps do you tke to secure trget vehicles (high vlue vehicles nd lods etc)? 4
(d) Wht security rrngements re in plce for uncoupled semi-trilers or drwr trilers prked outside or wy from your own premises (e.g. 5th wheel pin lock/leg lock etc)? Plese indicte the numer of vehicles fitted with tchogrphs. Anlogue. Digitl. (f) If nlogue tchogrphs re fitted, plese dvise: How often do you check the chrts? Are they nlysed in house or y ureu? If ureu, plese give the nme of the compny (g) If digitl tchogrphs re fitted, plese dvise: (iv) The mnufcturer of your digitl tchogrph oxes? How often do you downlod the dt from the vehicles? Is the dt nlysed in house or y ureu? If y ureu, plese give the nme of compny 6 Opertions () Do you hve full time fleet trnsport mnger? If plese give nme nd qulifictions. If do you use n gency trnsport mnger? If plese give detils. () Wht types of goods re crried? (c) Do your vehicles visit ny hzrdous sites (e.g. Airports, chemicl works, power sttions, militry/mod sites etc)? If plese give: The nmes of the sites visited. Ares within the site you operte (e.g. plne side, unrestricted site ccess). The frequency of visits. (iv) The percentge of nnul turnover ssocited with such visits. 5
(d) Do you crry or re likely to crry, ny goods or mterils which re of hzrdous nture? Are hzrdous goods crried in tnkers or s ulk lods? If plese complete the following tle (see ppendix t the end of the document for detils). UN Clss Division Pcking Group Trnsport Ctegory 1 Nture of Goods of nnul Turnover of nnul turnover crried in ulk or tnkers 2 2.1 2.2 2.3 3 4 4.1 4.2 4.3 5 5.1 5.2 6 6.1 6.2 7 8 9 Do you crry High Consequence Dngerous Goods (refer to the ppendix t the end of the document for detils)? If : Do you crry such goods in ulk lods or tnkers? Plese give detils of the Clss/Division of the goods crried. (iv) How mny yers hve you een involved with hzrdous goods? (v) Plese give the nme of your ppointed Dngerous Goods Sfety Adviser. (vi) How mny of your drivers hold ADR qulifictions? Wht is the usul rdius of your opertions? (f) How often do your vehicles operte overses (cn you estimte the numer of vehicle dys per nnum)? Within EU Outside EU If vehicles operte outside the EU, plese give detils of the Countries visited. 7 Additionl Informtion () Do you use the services of n independent Accident Mngement Compny? If plese give the nme of the compny nd the dte the service commenced. () Your Aviv insurers cn ssist my you e with le your to ssist risk you mngement with your risk progrmme mngement y providing progrmme clims y providing informtion clims nd informtion ccident reports nd ccident which you reports cn which use to you nlyse cnuse your to Fleet nlyse ccident your Fleet record ccident nd offering record nd prcticl offering dvice prcticl nd ccess dvice to nd risk ccess mngement to risk mngement solutions to solutions meet your to meet specific yourspecific needs. needs. Would you e interested in further detils? 6
Plese red the informtion elow crefully Dt Protection Act Act Informtion Uses Uses For the the purposes of of the the Dt Dt Protection Protection Act 1998 Act the 1998 Dt the Controller Dt Controller in reltion to in ny reltion personl to ny dt personl you supply dt to is your supply intermediry, to is Aviv Anthony Insurnce Jones (UK) UKLtd. Limited. Insurnce Administrtion Your informtion my e used for the purposes of insurnce dministrtion y the insurer, its ssocited compnies nd gents, y re-insurers nd your Insurnce intermediry. Administrtion It my e disclosed to regultory odies for the purposes of monitoring nd/or enforcing the insurer s complince with ny regultory rules/codes. Your informtion my my lso e e used for offering the purposes renewl, of reserch insurnce nd dministrtion sttisticl purposes y the nd insurer, crime prevention. its ssocited It my compnies e trnsferred nd to ny gents, country, y re-insurers including nd countries your outside intermediry. the Europen It my Economic e disclosed Are for to ny regultory of these purposes odies for nd the for systems purposes dministrtion. of monitoring Where nd/or this hppens, enforcing we the will insurer s ensure tht complince nyone to with whom ny we pss regultory your informtion rules/codes. grees Your to tret informtion your informtion my lso with e the used sme for level offering protection renewl, s if reserch we were nd deling sttisticl with it. purposes nd crime prevention. If you give us informtion It my e trnsferred out nother to person, ny country, in doing including so you confirm countries tht they outside hve given the you Europen permission Economic to provide Are it to for us nd ny for of us these to e purposes le to process nd for systems their personl dministrtion. dt (including Where ny sensitive this hppens, personl dt) we will nd lso ensure tht tht you hve nyone told them to whom we re pss nd your wht informtion we will use their grees dt for, to tret s set your out in this notice. informtion In the cse of personl with the dt, sme with level limited of protection exceptions, s nd if on we pyment were deling of the pproprite with it. fee, you hve the right to ccess nd if necessry rectify informtion If held you out give you. us informtion out nother person, in doing so you confirm tht they hve given you permission to provide it to us nd for us to In ssessing e le ny to process clims mde, their the personl insurer dt or its gents (including my undertke ny sensitive checks personl ginst dt) pulicly nd ville lso tht informtion you hve (such told s electorl them who role, we county re court nd wht we will judgements, use their nkruptcy dt for, orders s set or out repossessions). in this notice. Informtion my lso e shred with other insurers either directly or vi those cting for the insurer (such s loss djusters or investigtors). In the cse of personl dt, with limited exceptions, nd on pyment of the pproprite fee, you hve the right to ccess nd if necessry Credit Serches nd Accounting rectify informtion held out you. In ssessing your ppliction/renewl, to prevent frud, check your identity nd to mintin its policy records, the insurer my serch files mde ville to it In y ssessing credit reference ny clims gencies, mde, who my the keep insurer record its of gents tht serch. my undertke The insurer my checks lso ginst pss to credit pulicly reference ville gencies informtion (such it holds s electorl out you role, nd county your pyment court record. judgements, The informtion nkruptcy will e orders used y or other repossessions). credit lenders Informtion mking credit my decisions lso e shred out you with nd other people insurers with either whom directly you re or finncilly vi those ssocited cting for frud for the prevention, insurer (such money s lundering loss djusters prevention or investigtors). nd for trcing detors. The insurer my sk credit reference gencies to provide credit scoring computtion. Credit scoring uses numer of fctors to work out risks involved in ny Credit Serches nd Accounting ppliction. A score is given to ech fctor nd totl score otined. Where utomtic credit scoring computtions re used y the insurer, cceptnce or In ssessing your ppliction/renewl, to prevent frud, check your identity nd to mintin its policy records, the insurer my serch files rejection of your ppliction will not depend only on the results of the credit scoring process. mde ville to it y credit reference gencies, who my keep record of tht serch. The insurer my lso pss to credit reference Sensitive Dt gencies informtion it holds out you nd your pyment record. The informtion will e used y other credit lenders for mking credit In order to ssess the terms of the insurnce contrct or dminister clims tht rise, the insurer my need to collect dt tht the Dt Protection Act defines decisions s sensitive out (such s you medicl nd history the people or criminl with convictions). whom you By re proceeding finncilly with ssocited this ppliction/renewl for frud prevention, you will signify money your lundering consent to such prevention informtion nd eing for trcing processed detors. y the insurer or their gents. The Mrketing insurer my sk credit reference gencies to provide credit scoring computtion. Credit scoring uses numer of fctors to work out risks Your insurers, involved its in gents, ny ppliction. usiness prtners A score nd is other given crefully to ech selected fctor compnies nd totl my score use your otined. informtion Where to keep utomtic you informed credit y scoring post, telephone, computtions fcsimile, re e-mil, used text y messging the insurer, or other cceptnce mens out or rejection products nd of your services ppliction tht my e will of not interest depend to you. only Your on informtion the results my of lso the e credit disclosed scoring nd process. used for these purposes fter your policy hs lpsed. By providing us with your contct detils you consent toeing contcted y these methods for these purposes. If you do Sensitive not wish to receive Dt mrketing informtion, plese contct your intermediry In order to ssess the terms of the insurnce contrct or dminister clims tht rise, the insurer my need to collect dt tht the Dt Frud Prevention nd Detection Protection In order to prevent Act defines nd detect s sensitive frud your (such insurers s medicl my t ny history time: or criminl convictions). By proceeding with this ppliction/renewl you will signify your consent to such informtion eing processed y the insurer or their gents. shre informtion out you with other orgnistions nd pulic odies including the Police undertke credit serches nd dditionl frud serches Mrketing check nd/or file your detils with frud prevention gencies nd dtses, nd if you give us flse or inccurte informtion nd we suspect frud, we will Aviv record Group, this. its gents, usiness prtners nd other crefully selected compnies my use your informtion to keep you informed y post, telephone, Insurers cn supply fcsimile, on request e-mil, further text messging detils of the or dtses other mens they ccess out or products contriute nd to. services tht my e of interest to you. Your informtion my Your insurers lso e nd disclosed other orgnistions nd used for my these lso serch purposes these fter gencies your nd policy dtses hs lpsed. to: By providing us with your contct detils you consent to eing help mke contcted decisions y out these the methods provision for nd these dministrtion purposes. of If insurnce, you do not credit wish nd to relted receive services mrketing for you informtion, nd memers of plese your household write to Aviv, FREEPOST, trce detors Miling or eneficiries, Exclusion recover Tem, det, PO Box prevent 6412, frud Dery, nd to DE1 mnge 1SB. your ccounts or insurnce policies check your identity to prevent money lundering, unless you furnish us with other stisfctory proof of identity. Frud Clims History Prevention nd Detection In Under order the to conditions prevent of nd your detect policy frud you must we tell my your t insurers ny time: out ny insurnce relted incidents (such s fire, wter, dmge, theft or ccident) whether or not they give rise to clim. When you tell your insurers out n incident they will pss informtion relting to it to dtse. shre informtion out you with other orgnistions nd pulic odies including the Police They my serch these dtses when you pply for insurnce, in the event of ny incident or clim, or t ny time of renewl to vlidte your clims history or tht of undertke ny person credit or property serches likely nd to e dditionl involved in frud the policy serches or clim. Motor check Insurnce nd/or Dtse file your detils with frud prevention gencies nd dtses, nd if you give us flse or inccurte informtion Your policy detils will e dded to the Motor Insurnce Dtse (MID), run y the Motor Insurers Informtion Centre (MIIC). MID dt my e used y the nd we suspect frud, we will record this. DVLA nd DVLNI for the purpose of Electronic Vehicle Licensing nd y the Police for the purposes of estlishing whether driver s use of the vehicle is likely to We e covered cn supply y motor on request insurnce further policy detils nd/or for of preventing the dtses nd detecting we ccess crime. or contriute If you re involved to. in n ccident (in the UK or rod), other UK insurers, the Motor Insurers Bureu nd MIIC my serch the MID to scertin relevnt policy informtion. We Persons nd with other vlid orgnistions clim in respect my of lso rod serch trffic these ccident gencies (including nd citizens dtses of other to: countries) my lso otin relevnt informtion which is held on the MID. help mke decisions out the provision nd dministrtion of insurnce, credit nd relted services for you nd memers of your You cn household find out more out this from your insurer, or t www.miic.org.uk You should trce show detors these or notices eneficiries, to nyone recover insured det, to drive prevent vehicle frud covered nd under to mnge the policy. your ccounts or insurnce policies Telephone Cll Recording check your identity to prevent money lundering, unless you furnish us with other stisfctory proof of identity. For our joint protection nd trining purposes telephone clls my e recorded nd/or monitored. Clims Mteril History Fcts Under Plese rememer the conditions tht you of must your inform policy the you insurer must of tell ny us circumstnces out ny of insurnce which the relted insurer my incidents not e (such wre. s Filure fire, wter, to do so dmge, could invlidte theft or the ccident) policy. If you re in ny dout s to whether fct is mteril it should e disclosed to the insurer. If there hve een ny chnges in circumstnces tht hve risen since whether or not they give rise to clim. When you tell us out n incident we will pss informtion relting to it to dtse. this insurnce ws tken out or lst renewed plese inform us. We This renewl my serch invittion these is mde dtses on the when sis of you the pply informtion for insurnce, your insurers in the hve event t the of time ny it is incident issued. They or clim, my revise or t or ny withdrw time of it if, renewl efore the to vlidte your your renewl clims tkes history effect, ny or tht event of occurs ny person tht gives or rise property to clim likely or lters to e the involved mteril in fcts the under policy this or insurnce, clim. even if we or your insurers re notified fter your Motor renewl dte. Insurnce Dtse Your should policy keep detils record will e (including dded copies to the of Motor letters) Insurnce of ll informtion Dtse supplied (MID), to the run insurer y the for Motor the purposes Insurers of the Informtion renewl of Centre this insurnce. (MIIC). MID dt my If You e hve used Complint y the DVLA nd DVLNI for the purpose of Electronic Vehicle Licensing nd y the Police for the purposes of estlishing whether We hope tht driver s you will use e of very the hppy vehicle with is the likely service to your e covered we our your y insurers motor provide. insurnce However, policy if nd/or for ny reson for preventing you re unhppy nd detecting with this, crime. we would If you like re to involved her from in you. n In ccident the first instnce, (in the UK plese or contct rod), us. other UK insurers, the Motor Insurers Bureu nd MIIC my serch the MID to scertin relevnt Choice of policy Lw informtion. The pproprite lw s set out elow will pply unless you nd the insurer gree otherwise: Persons with vlid clim in respect of rod trffic ccident (including citizens of other countries) my lso otin relevnt informtion which 1) The lw is held pplying on the in tht MID. prt of the UK, Chnnel Islnds or Isle of Mn in which you normlly live or (if pplicle) the first nmed policyholder normlly lives; or 2) In the cse of usiness, the lw pplying in tht prt of the UK, Chnnel Islnds or Isle of Mn where it hs its principl plce of usiness; or You 3) Should cn find neither out of more the ove out e this pplicle, from your the lw insurer, of Englnd or t nd www.miic.org.uk Wles will pply. You Copy should Policy Avilility show these notices to nyone insured to drive vehicle covered under the policy. If t ny stge you would like to receive new copy of your policy ooklet, plese contct us. 7
Copy Policy Avilility If t ny stge you would like to receive new copy of your policy ooklet, plese contct either your regulr Aviv point of contct or your insurnce roker, t the ddress shown on your policy schedule. Declrtion I/We understnd the contents of this completed ppliction nd I/We declre tht the informtion given is, to the est of my/our knowledge nd elief, correct nd complete. I/We gree tht the sttements in this ppliction shll form the sis of the contrct etween the insurer nd myself/ourselves nd if the risk is ccepted I/We undertke to py the premium when clled upon to do so. I/We understnd tht my/our informtion my lso e disclosed to regultory odies for the purposes of monitoring nd/or enforcing the insurer s complince with ny regultory rules/codes. Signture Nme Position Dte dd/mm/yy Aviv Insurnce UK Limited Registered in Englnd No 99122 Registered Office: 8 Surrey Street, Norwich, NR1 3NG Authorised nd Regulted y the Finncil Services Authority BCOSA3386 6.29 (A) 8
Appendix 1 Definitions of Hzrdous Goods UN Clssifictions Clss 1 Explosives Sudivided into 6 groups 1.1 to 1.6 Clss 2 Gses Covers ll compressed gses including flmmle nd toxic. Sudivided into: 2.1 flmmle gses 2.2 non-toxic, non-flmmle compressed gses 2.3 toxic gses. Clss 3 Flmmle liquids Give off vpour which urns in ir if ignited. Clss 4 Other flmmles Sudivided into: 4.1 flmmle solids 4.2 spontneously comustile 4.3 dngerous when wet. Clss 5 Oxidisers Sudivided into: 5.1 oxidising gents 5.2 orgnic peroxides. Clss 6 Toxics Sudivided into: 6.1 poisonous/toxic sustnces 6.2 infectious sustnces. Clss 7 Rdioctives Not sudivided ut there re 3 levels of dnger. Clss 8 Corrosives My cuse serious urns etc. Clss 9 Miscellneous Covers ny other sustnce clssified s dngerous y the UN which does not redily fit into one of the ove clsses. Pcking Groups Dngerous Goods tht re crried in pckges re lso ssigned Pcking Group depending on the nture of the risk. Pcking Group I High Dnger Pcking Group II Medium Dnger Pcking Group III Low Dnger Trnsport Ctegories All dngerous goods re llocted trnsport ctegory rnging from to 4. These vlues re used to to determine whether the totl quntity of goods crried is sufficiently lrge enough to fll within the regultions. TC reltes to certin highly dngerous infectious sustnces. TC1 represent the most dngerous products such s toxic compressed gses. TC3 re less dngerous sustnces. TC4 re deemed so sfe most of the regultions do not pply. When determining whether the regultions pply for lods of the sme trnsport ctegory, the totl quntity in litres or kilogrms must exceed the threshold for the relevnt trnsport ctegory. Trnsport Ctegory TC TC1 TC2 TC3 TC4 Totl mss or volume of pckged dngerous goods for regultions to pply Alwys pplies >2 >333 >1 Never pplies If the lod is of mixed ctegories then refer to the regultions s different lod thresholds pply, clculted y mens of mixed lod multiplier. High Consequence Dngerous Goods Are those which hve the potentil for misuse in terrorist incident which my s result, produce serious consequences such s mjor csulties or mss destruction. Specil security provisions hve to e pplied whilst such goods re crried. High Consequence Dngerous Goods re listed elow nd crried in quntities greter thn those indicted. Clss 1 2 3 4.1 4.2 4.3 5.1 6.1 6.2 7 8 Division Sustnce or rticle 1.1 1.2 1.3 1.5 Corrosive sustnces of pcking group 1 KEY Not relevnt. The provisions of ADR 1.1.3 do not pply. Quntity Tnk (l) Bulk (kg) Pckges (kg) Explosives Explosives Comptiility group C explosives Explosives Flmmle gses (clssifiction code F) Toxic gses (clssifiction codes including letters T, TF, TC, TO, TFC or TOC) excluding erosols Flmmle liquids of pcking groups 1 nd 2 Desensitivised explosives Desensitivised explosives Pcking group 1 sustnces Pcking group 1 sustnces Oxidizing liquids of pcking group 1 Perchlortes, mmonium nitrte nd mmonium nitrte fertilizers Toxic sustnces of pcking group 1 Infectious sustnces of Ctegory A 3 3 3 3 3 3 3 3 Rdioctive mteril 3 A1 (specil form) or 3 A2, s pplicle in Type B or Type C pckges 3 1