TEMPORARY COVER NOTE

Policy no. (if any) Authorised Insurers. AC SMF 4167513 AXA

Name of Insured: AG Corp
Advice to third parties – nothing contained in this certificate affects your right as a third party to make a claim.
Limited

Address: INNOVATION CENTRE, Authorised Driver: Agent:

MARSH WALL, SOUTH Licence Number: MASOO905119MI9MZ Broadsure Direct Limited DVLA Check: Yes
QUAY, E14 9FW

Reason for issue: _ New Policy _ SV-subst. of veh. _ AV-addtnl. veh. X Temporary Change

_ CU-change of use _ RG-correct reg.no _ Continuation cover note _ CO-change of cover

_ CS-change of style _ Change of policy interest _ CD-change in driving _ Other

Operative from: 30/09/17

09/10/20
28 September 2017 11:00 09/11/20
30/10/17
27 October 2017 11:00

Vehicle details: Any motor vehicle the property of the insured or in their custody or control or for which they are legally responsible.
Make/Model Registration no. CC GVW (Kg) Year
W894REW
WO66 FKT 500XNissan micra
CROSS + MULTIJET WHITE

Policy Cover: _ Comprehensive Gold _ Comprehensive _ Third Party Fire & Theft X Third Party Only

Persons Permitted To Any licensed driver driving on the order or with the permission of the Policyholder provided that the policy terms and
Drive: conditions have been met.

Use: Use for Social Domestic and Pleasure Purposes and for the business of the Insured and the Insured’s employer or partner
excluding use for hiring, the letting on hire, the carriage of passengers or goods for hire or reward, racing, pacemaking,
use on any track, test circuit or off road activity, use in any contest, reliability or speed trial, or use in connection with the
Motor Trade.

Excesses That Apply: Please refer to the relevant endorsement for details of any excess that might apply in the event of a claim for Windscreen
cover. Young/ inexperienced Driver excesses may also apply. Please refer to your Schedule for details.

Special Conditions: Cover will only operate if the person driving holds a licence to drive the vehicle or has held and is not disqualified from
holding or obtaining such a licence.

Received on the issue £ NIL

of this cover note: (insert the
amount or
09/10/20
30/09/17
Date of issue: 28 September 2017

‘Nil’)
The Company, AG Corp Limited, hereby certifies that this cover note satisfies the requirements of the relevant law in Great Britain, Northern Ireland,
the Isle of Man, the Island of Guernsey, the Island of Jersey and the Island of Alderney.

AG Corp Limited
Registered in England and Wales, No. 09683556
Registered Office: Innovation Centre, Marsh Wall, South Quay, E14 9FW

Temporary Cover note no.

LTX9 183 9898