ROAD RISKS PROPOSAL FORM - Granite Underwriting
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ROAD RISKS PROPOSAL FORM
Granite Underwriting limited
Form GU-VRR002Daniel 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 a dded 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 Under writing 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
Email 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 1Tell 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?
Years
C) Approximately when was the business established
Years
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 26.8 Motorised Horseboxes %
6.12 Imports / Export of Vehicles % Being driven on trade plates or UK registered only. Otherwise excluded.
6.13 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 )
Years Full Status Use
Date of Driving Licence
Name UK Licence (Driver code) B/C/P/OB
Birth number
held * **
Page 310. 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
Disqualification period
Driver Date of Conviction Conviction Code Penalty points
(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:
Conviction or Do you or did you admit
Driver Offence Penalty Imposed (***)
Caution date * the offence ? (yes or no)
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 1974. 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
Yes or No
a) defective vision or hearing (if not corrected by glasses, contact lenses or hearing aid?
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 414 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 Yes No
made or whether or not the loss was covered by insurance?
If the answer to Section 14 (b) is ‘Yes’ then please provide full details below:
Was bonus
Incident Code effected? (Yes / Estimated
Driver Name Date of Incident (see codes below) No) 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: Number of years claims free
Motor Trade Years
Private Motor Years
Commercial Vehicle Years
Taxi - Public / Private Hire Years
Motorcycle Years
Fleet or other type Years
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 Years
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 5D Vehicles to be Covered
17. Vehicles Owned - Cars and light vans (include vehicles held for sale)
Year of Present
Make & Model Date of Purchase Sale vehicle or Own Use? Registration Number
Make Trade Value
Vehicles owned - please list ALL vehicles owned with a gross vehicle weight in excess of 3.5 tonnes
Gross Vehicle Type of Number of vehicles
Make & Model Present Value Registration Number
Weight Body carried (see note 2)
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
£250 £500 £750
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 6F 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
st
1 Driver Name
nd
2 Driver Name
7. Vehicles in Transit
Yes No
Do you require this cover?
Total Load
Maximum value any one vehicle £ £
Value
Transporter Reg. No. / Trailer Serial number
Max number of vehicles carried any one time
8. Specified Trailers
Do you require this cover? Yes No
Trailer serial number
Value £
Trailer serial number
Value £
Page 7H 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 8Declaration
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 polic y 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.
Print Name here
Proposer's Signature(s)
Capacity in which signed (Please delete whichever does not apply) Proposer Partner Director
Date Signed
Page 9Notice 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 www.fsa.gov.uk/register
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 311873
Haven Insurance Company Limited
Suite 913B, Europort, Gibraltar
Registered with the Financial Services Authority No 221269
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.
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