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Policy Underwritten By:

U K Insurance Limited
Darwin Motor
Policy Number: 00027864
Operator: idg_webintBrokers ID: 2270
CDL Version: 1.04 Client: Y0/162881/001
Printed: 28/05/21 @ 22:35 A_Y0PCXPRO
© Copyright 2017 Cheshire Datasystems Limited

Customer Hotline
0345 246 2083
Claims Hotline
0345 246 2089
Motor Proposal Issued 28/05/21
Confirmation
POLICY NUMBER 00027864 Reference: 162881/001

WHAT TO DO Please check this form and
ensure that the information
provided is correct. You must
take care to provide us with
accurate information.
If all the information is correct, keep this form in a safe place with
your policy.
If any of these details are incorrect, no longer entirely accurate
or if you are unsure about them, then please call us immediately
as incorrect information could adversely affect your policy,
including invalidating your policy and causing claims to be rejected
or not fully paid. You can call us to advise us of any inaccuracies.
Please keep this document in a safe place with your other policy
documents.
You can call us on 0345 246 2083 to advise us of any
inaccuracies.

POLICYHOLDER Name Mr Rafal Siejka

Date of Birth 18/07/88
Marital Status Civil Partnered
Correspondence Address 14 Horninglow Croft
Burton-on-Trent
DE13 0SJ
Legal Owner of the car Mr Rafal Siejka
Registered Keeper of the car Mr Rafal Siejka
Home owner Information not supplied
Total No. of cars at home 2
Contact Number 07517794049 Mobile

POLICY DETAILS Period of Insurance 28/05/21 (22:35 hours) to 03/05/22 (23:59 hours)
Cover Comprehensive

Use Social, domestic and pleasure purposes including

driving to and from a permanent place of work.

Main Driver Mr Rafal Siejka

You have NEVER had insurance cancelled by an insurer.
Please check the information about drivers on the next page of this document.

Please check the information and read the declaration on the

next page of this document.
Darwin® insurance policies are underwritten by U K Insurance Limited. Registered office: The Wharf, Neville Street, Leeds LS1 4AZ Registered in England and Wales No.1179980. U K
Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Calls may be recorded.
 Policy Underwritten By:
U K Insurance Limited
Darwin Motor
Policy Number: 00027864
Operator: idg_webintBrokers ID: 2270
CDL Version: 1.04 Client: Y0/162881/001
Printed: 28/05/21 @ 22:35 A_Y0PCXPRO
© Copyright 2017 Cheshire Datasystems Limited

CAR DETAILS Make and Model of car VOLKSWAGEN TOUAREG SPORT V6 TDI (225)
Registration Number WN55WGW

Manufactured 2005

Estimated Value Market Value (not exceeding £75,000)

We will not pay more than the market value of your car at
the time of loss (less any excess that may apply).

Purchase Date 01/05/20

Modifications None
Postcode where vehicle kept DE13 0SJ
Estimated Annual Mileage Not more than 3,000

PAYMENT DETAILS Your chosen method Payment In Full

NO CLAIM DISCOUNT No Claim Discount Entitlement 5 years

No Claim Discount Protection Included

DETAILS OF SPECIFIC Mr Rafal Siejka (main driver): 32 years old

DRIVERS • Tyre Inspector • No convictions, endorsements, fixed penalties or
If any details are incorrect, • Full Licence issued in UK, held for over 14 years disqualifications including points in the last 5
• UK resident since 01/09/11 years.
please notify us immediately. • Accidents, claims or losses in the last 5 years:
Multiple Vehicle / Third Party Hit Driver - Nov 19

IMPORTANT NOTES • The Road Traffic Act states that it is an offence to make a false statement, or to withhold
information, to obtain a certificate of motor insurance.
• If anything on the Motor Proposal Confirmation is incorrect, no longer entirely accurate, or if you
are unsure about any details, please call us immediately. Failure to do so could invalidate your
policy.
• If you give us any additional information, for instance in a letter, please keep a copy for yourself.

DECLARATION Please check that this policy meets your needs. It is based on the most up to date information
provided by you. You must take care to provide us with accurate information and you should notify
us immediately if anything is incorrect or if you are unsure about any details. Providing inaccurate
information could adversely affect your policy, including invalidating your policy and causing claims
to be rejected or not fully paid. You can call us to advise us of any inaccuracies.
Should any of the information contained in this Motor Proposal Confirmation and your Policy
Schedule change during the period of insurance you should notify us immediately.
I accept the insurance, subject to the terms and conditions set out in the Policy I have received.

Darwin® insurance policies are underwritten by U K Insurance Limited. Registered office: The Wharf, Neville Street, Leeds LS1 4AZ Registered in England and Wales No.1179980. U K
Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Calls may be recorded.