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Policy underwritten by: Policy Expert car insurance
Policy number: PEPL0231008
Operator: icl_webint Broker ID: 1912
CDL version: 1.08 Client: BD/5373546/001
Printed: 10/02/25 @ 17:10 A_RGPCXSOF
© Copyright 2017 Cheshire Datasystems Limited
Statement of facts
Agents details No. of seats: 2
Name: Policy Expert (a trading name of QMetric Year of make: 2004
Group Limited)
Address: Maxim 3, 2 Parklands Avenue, Registration number: KN04UXG
Holytown,
Motherwell, Legal owner: Policyholder
ML1 4WQ
Registered keeper: Policyholder
This is an important document and must be read in conjunction
with your Policy Schedule, and Certificate of Motor Insurance, Has this car been changed in any No
which together form your contract of insurance. Read it carefully way from the car manufacturer’s
and advise us immediately should any of the information be wrong standard specification?
or there is any missing. You will be advised of any change to your
premium or the terms we require and sent a new form. Failure to This would include:
supply accurate and complete answers may mean that your policy • Changes to the bodywork, such as
is invalid and that it does not operate in the event of a claim, keep spoilers or body kits. Changes to
this document in a safe place together with your Policy Schedule suspension or brakes.
and Certificate of Motor Insurance.You should also keep evidence • Cosmetic changes such as alloy
of any No Claims Discount that you are claiming as we may require wheels or paint.
confirmation, in the future. Failure to provide confirmation could • Changes affecting performance such
result in an additional premium or a claim not being paid. as changes to the engine
management system or exhaust
system.
1. Your details • Changes to the audio/entertainment
system.
Please be aware that this is not a full list
Name: Miss Fiona Walsh of all possible changes- all changes made
from the manufacturer’s standard
Address: 3 Red Lion Square specification must be disclosed.
The Street Has an alarm, immobiliser or Yes
Plaxtol tracking system been fitted? Alarm: Factory Fitted
Sevenoaks Immobiliser: FF Thatcham 1
Postcode: TN15 0QE
Policy number: PEPL0231008 3. Cover required
Postcode where car is As address Cover: Comprehensive
kept:
Voluntary excess: £100
Where is the car kept Garage
overnight?
Do you own your own Yes
home? 4. Use required
Class of use: Class one - Business use by the
Policyholder only
2. Car details
Make & model: AUDI TT QUATTRO (180) CABRIOLET
(state if GL, DTI etc.)
Right hand drive? Yes
Engine size: 1781cc
Date of purchase: 01/05/2024
Estimated value: £700
Estimated annual 2,000
mileage:
Policy Expert is a trading name of QMetric Group Limited. Authorised and regulated by the Financial Conduct Authority. Firm reference number 529506.
Statement of Facts (page 2 of 4)
5. Previous insurance details
Previous insurer: Number of years No 9
Claims Discount:
Policy number: Do you wish to protect your No No
Claims Discount?
Renewal date: 16/02/2025
6. Drivers required
Yourself only ✔ You & the named driver(s) below
Driver 1 (you) Driver 2 Driver 3 Driver 4 Driver 5
Driver's name
Marital status Divorced
Relationship to driver 1 (you)
Date of birth 27/08/1963
Occupation Care Assistant
Type of business Health Care - Private
Occupation - part time Not In Employment
Type of business Not In Employment
Type of licence held (Full UK etc) Full Licence
Number of years licence held 25
Date from which driver has been resident in the 27/08/1963
UK
Will this driver use the vehicle for commuting? Yes
Is this driver a main user? Yes
Does this driver own any other vehicle? No
Has this driver use of any other vehicle? No
Has this driver ever been refused insurance or had No
their policy cancelled?
Has this driver had or caused any accidents, claims
or damage involving any motor vehicle (including
car, motorcycle or van) in the past 5 years, whether If 'yes' the details are shown in point 7 on page 3
or not a claim was made, and regardless of blame?
Has this driver had any motoring convictions,
driving licence endorsements, fixed penalties or
been disqualified from driving in the last five years? If 'yes' the details are shown in point 8 on page 3
- Does this driver have any pending prosecutions
for any motoring offence?
Does this driver suffer from any physical or mental
disability, illness or medical condition? If 'yes' the details are shown in point 9 on page 3
Policy Expert is a trading name of QMetric Group Limited. Authorised and regulated by the Financial Conduct Authority. Firm reference number 529506.
Statement of Facts (page 3 of 4)
7. Accidents, claims or losses
Driver's name Date of incident Brief details of what happened At fault NCD affected?
None
8. Convictions
Driver's name Conviction date Offence code (see licence) Fine Points Length of any disqualification
None
9. Disabilities and medical conditions
Date Condition DVLA Restricted
Driver's name Details
diagnosed status informed? Licence?
None
Policy Expert is a trading name of QMetric Group Limited. Authorised and regulated by the Financial Conduct Authority. Firm reference number 529506.
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Statement of Facts (page 4 of 4)
Important notes
1. Your policy will be based on the answers provided in this statement of facts. Your answers will influence the acceptance and
assessment of this proposal. If you are in any doubt about whether a piece of information is relevant to your answer, please contact
us.
2. It is an offence under the Road Traffic Act to make false statement or withhold information for the purposes of obtaining a Certificate
of Motor Insurance.
3. You are required by the Consumer Insurance (Disclosure and Representations) Act to take reasonable care to supply accurate and
complete answers to all the questions on the statement of facts and to make sure that all information supplied is true and correct.
Failure to supply accurate and complete answers may mean that your policy is invalid and that it does not operate in the event of a
claim.
4. We recommend that you keep a copy of all information (including copies of any letter or other documents) supplied to us.
5. Cover will not start until a Certificate of Motor Insurance or Cover Note is issued.
6. The insurer reserves the right to decline this Proposal or to offer a policy containing restrictions in cover.
7. Unless we agree otherwise, English law will apply to this contract of insurance.
8. A specimen of our current policy is available on request.
Customer service
We aim to give you the best possible service, but if you have any questions or concerns about this insurance or the way we have handled
your claim, you should follow the complaints procedure set out in your policy wording.
Policy Expert is a trading name of QMetric Group Limited. Authorised and regulated by the Financial Conduct Authority. Firm reference number 529506.
