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Policy Number 777771044261

Agency Number 77777

Agent Ref 2031772/001

STATEMENT OF INSURANCE
IMPORTANT: Please read and check the information shown in this document very carefully. The information displayed in this document represents the answers that were given at the time of your Contract
of Insurance. Please notify us immediately of any changes to these details. This document should be read in conjunction with your Policy Wording, Policy Schedule and Certificate of Motor Insurance.

INSURERS MAINTAIN A MOTOR INSURANCE ANTI-FRAUD AND THEFT REGISTER AND EXCHANGE INFORMATION WITH EACH OTHER TO PREVENT FRAUDULENT CLAIMS. IT IS OUR
PRACTICE TO CO-OPERATE WITH POLICE AUTHORITIES IN BRINGING PROSECUTIONS WHERE FRAUDULENT CLAIMS ARE DETECTED.

1. Proposer’s Name and address Contact Numbers

Name Mr Muhammad Afaq Home 07632 514258
Address 51c, Belle Vue Road, Easton, BRISTOL Work 07632 514258
Email Muhamadfaq215@[Link] Post code BS5 6DR Mobile 07632514258

2. Period of insurance to commence from 25/01/2025 00:00 hrs For 3 Months

3. Please provide the following details of YOURSELF and ALL OTHER DRIVERS
Driver 1 Driver 2 Driver 3 Driver 4 Driver 5
Title Mr
First Name (s) Muhammad
Last Name Afaq
Relationship to Proposer N/A
Sex Male
Date of Birth 2 July 1998
Marital Status Civil Partnership
UK Residency Date 1 March 2024
Driver Status/Use Main User
Licence Type Full Licence
Licence Date 30 September 2024
Licence No. -
Main Occupation Student - Living Away
Main Employer’s Business None - Student
Main Employment Status Full Time Education
Additional Occupation Accountant
Additional Business Accountancy
Additional Employment Status Employee
Access to other Vehicle -
Dwelling Type -
Smoker -
Pass Plus No
Highest Level of Education Unknown

4. Vehicle Details

Make and Model (ABI Code) Registration Number Year of Manufacture Date of Purchase Estimated Price Paid
Value
SUZUKI SWIFT SZ3 (48517102) SA60OVZ 2010 1 April 2024 £3,295 £3,295
Who is the Vehicle Owner? Is the Proposer the Registered Vehicle Postcode Fuel Engine CC Business Total Annual
Keeper? Mileage Mileage
Proposer/Policyholder Yes BS5 6DR Petrol 1242 - 3,000
Modifications Motoring Overnight Body Type Seats Doors Left Hand Current No of other
Organisation Location Drive Mileage Vehicles in
Household
Parked On
- None 5dr Hatchback 5 5 No - 0
Drive
Alarm Immobiliser Tracker Code

Factory Fitted Vehicle Manufacturer's Optional Equipment No Tracker

Third Party, Fire and Requested Voluntary

5. Please indicate type of cover required Who will Drive Insured Only £250
Theft Excess

Previously insured? If yes please provide details Yes Policy Number - Expiry Date 30 April 2024

Number of Years held Number of Years No

Name of Insurer - 0 0
Continuously? Claims
What type of policy was the No Claims Discount earned Was the No Claims Bonus Bonus being applied to
Private Car No No
under? Protected any other vehicle?

Do you require Protected No Claims Discount? No Class Of Use Social, Domestic & Pleasure - incl commuting

How often is the car used between 11pm and 6am? Other Previous Insurance Paid? Full Payment

24/07/18 GG Pc 1.0 Page 1 of 3

 6. Have you or any person who will drive:-

a) been refused Insurance, had an increased premium, had restricted terms imposed or had insurance cancelled or voided in the last five years? No

b) ever been convicted of any criminal offence (unspent under the Rehabilitation of Offenders Act 1974) or have any prosecution pending e.g. fraud, theft, acts of violence etc? No

c) been involved in any accident or loss, regardless of blame, in the last five years whether or not a claim was made? If yes, please give full details below No

d) had any motor vehicle stolen or suffered any loss by theft (including vandalism) of or from a motor vehicle (including motorcycles) in the last five years whether or not a claim
No
was made? If yes, please give full details below

Driver Date of Full Circumstances of Accident/Incident Claims Costs Third Party Costs Personal Did this affect Claim Made Under
Incident (own damage) Injury your NCB? this Policy?

No Claims

e) ever suffered or currently suffer from any physical or mental illness or defect, heart disease, epilepsy, diabetes or other infirmity or regularly take any prescribed drug?
No
If yes, please give full details below

Driver Date Description of Disability Condition Status DVLA Restricted Claims Has the Is treatment required?
Diagnosed Notified Licence? Arising vehicle been Please give details
Adapted?
No Medical Conditions

f) been convicted of a motoring offence, fixed penalty offence or non endorsable offences during the last five years, or have any prosecution pending?
No
If yes, please give full details below

g) been disqualified from driving in the last five years? If yes, please give full details below No

Driver Offence Date Conviction Offence Code Disqualification Conviction Points Fine Drink Drive Reading Relates to Accident
Date Period (Blood/Breath/Urine/Amount) Above

No Convictions

7. Additional Information

Peak Time Use: Yes

Children under 16: No

Imported: No

Daytime Location: Parked On Drive

8. Occasionally we, and other Go Girl group companies, would like to let you know about special offers, competitions and other information that is useful to you.
No
Please confirm if you would like to receive this information?

24/07/18 GG Pc 1.0 Page 2 of 3

IMPORTANT NOTICE
No cover attaches until Sabre Insurance Company Limited or its authorised agent has issued a Cover Note or Certificate of Motor Insurance. A copy of the policy wording and policy summary are available
on our website [Link]. We recommend you keep a record (including copies of letters and emails) of all information provided to us for your future reference. A copy of the completed application
form will be supplied at inception by your agent.

DATA PROTECTION
We are governed by the Data Protection Act (DPA) and the General Data Protection Regulation (GDPR), legislation which is applicable to the United Kingdom. Under this legislation we have to advise you
how we may use your details and tell you about the systems that we have in place to detect and prevent fraudulent applications and claims.

Information you supply may be used by us, our associated companies and agents, by reinsurers and your intermediary for the purposes of administering your policy. This information may be disclosed to
other regulatory bodies for the purposes of monitoring and/or enforcing our compliance with any regulatory rules or codes.

Your information may also be used for offering renewal, research and statistical purposes and crime prevention. It may be transferred to any country, including countries outside the European Economic
Area for any of these purposes and for systems administration. In order to assess the terms of the insurance contract or administer claims that arise, we may need to collect data that the DPA and GDPR
define as sensitive (such as driving licence information, medical history or criminal convictions). In assessing, investigating, handling and administering any claims made, we or our agents or investigators
appointed by us to assist in the processing of any claim you have presented may undertake checks against publicly available information (such as electoral roll, county court judgments, bankruptcy or
repossessions) and DVLA. These checks may also be carried out at the new business and/or renewal stage. We may review certain personal data and sensitive personal data about you and also the driver
of your vehicle who was involved in the incident giving rise to the claim, if different. Such personal data and sensitive personal data may include names, addresses, telephone numbers, occupations,
genders, dates of birth, driving licence details, details of any relevant accidents (including details of medical histories), details of thefts and details of criminal convictions or endorsements. This information
may also be used for the purposes of crime prevention in connection with claims, (e.g. the prevention of theft and/or fraud), assessing liability in respect of claims and to ensure that claims have been properly
represented.

Information may also be shared with other insurers either directly or via those acting for us (such as loss adjusters or investigators). You should show this notice to any driver covered or proposed to be
covered under this policy. By purchasing this policy you signify your explicit consent and the explicit consent of all relevant drivers to such information being processed by us and our agents and investigators
for the purposes set out above. With limited exceptions, you and any relevant third party noted in this paragraph have the right to access and, if necessary, rectify information held about you. Our full privacy
policy can be found at [Link]

24 hr Emergency Helpline - 0330 024 8000 - You should use the Helpline to report all ACCIDENTS or LOSSES covered under your policy.

IMPORTANT CHANGES
Under the terms of the Consumer Insurance (Disclosure and Representations) Act 2012, it is your responsibility to take reasonable care to supply complete and accurate information when you take out
your policy, throughout the life of your policy and when you renew your policy. Failure to notify the Insurer means that the policy may not operate to protect you. Important changes could include the
following: accidents (fault and non fault), thefts (of or from the vehicle), disqualifications, convictions (motoring and criminal), policyholder's address, health matters, make and model of vehicle, occupation
(full or part time), use of vehicle, vehicle modifications (cosmetic or performance enhancing), drivers, annual mileage, type of driving licence and date test passed. This is not an exhaustive list so if you
are in any doubt about whether or not facts may need to be considered you should disclose them. The Insurer reserves the right to decline any proposal or apply special terms.

FRAUD PREVENTION
Fraudulent claims are a serious problem for insurers and any costs arising from such activity are inevitably passed on to honest policyholders. In order to protect your interests and the interests of the vast
majority of our policyholders, we fully investigate all claims, and where fraud is detected we report to the authorities under the Proceeds of Crime Act 2002 (POCA).

Insurers pass information to the Claims and Underwriting Exchange Register and the Motor Insurance Anti-Fraud and Theft Register, run by Motor Insurers’ Bureau (MIB). The aim is to help insurers to
check the information provided and also to prevent fraudulent claims. When your request for insurance is dealt with, the registers will be searched. Under the conditions of your policy, we must be told
about any incident (such as an accident or theft) that may or may not give rise to a claim. In the event of a claim the information you supply together with any other information relating to the claim, will be
put on the register and made available to participants. It is our practice to co-operate fully with the Police authorities in the detection and prosecution of those involved in fraud.

If false or inaccurate information is provided and fraud is identified, details will be passed to fraud prevention agencies. Law enforcement agencies may access and use this information. We and other
organisations may also access and use this information to prevent fraud and money laundering, for example, when:
• checking details on applications for credit and credit related or other facilities.
• managing credit and credit related accounts or facilities & recovering debt.
• checking details on proposals and claims for all types of insurance.
• checking details of job applicants and employees.

Please contact us on 0330 024 4773 if you want to receive details of the relevant fraud prevention agencies. We and other organisations may access and use from other countries the information recorded
by fraud prevention agencies.

You may report information confidentially in respect of bogus/fraudulent claims to the Cheatline on 0800 422 0421. The Cheatline is manned 24 hours a day. Alternatively, fraud can be reported online to
the Insurance Fraud Bureau (IFB) at [Link] All information can be reported anonymously and will be treated in the strictest confidence. The Cheatline is manned by experienced
fraud investigators who may share the information with other interested parties such as the insurer concerned (if known). Savings obtained from information provided to the Cheatline will help to reduce
insurance premiums. More information can be provided if requested.

DVLA – MY LICENCE
By providing your Driving Licence Number when obtaining insurance you are consenting to us checking the DVLA register for details of your driving history and motoring convictions. You can check the
information held by the DVLA about you by visiting their website [Link]

MOTOR INSURANCE DATABASE

Information relating to your insurance policy will be added to the Motor Insurance Database (MID) managed by the Motor Insurers' Bureau (MIB). MID and the data stored on it may be used by certain
statutory and/or authorised bodies including the Police, the DVLA, the DVANI, the Insurance Fraud Bureau and other bodies permitted by law for purposes not limited to but including:

• Electronic Licensing;
• Continuous Insurance Enforcement;
• Law enforcement (prevention, detection, apprehension and/or prosecution of offenders);
• The provision of government services and/or other services aimed at reducing the level and incidence of uninsured driving.

If you are involved in a road traffic accident, (either in the UK, the EEA or certain other territories), Insurers and/or the MIB may search the MID to obtain relevant information. Persons (including appointed
representatives) pursuing a claim in respect of a road traffic accident (including citizens of other countries) may also obtain relevant information which is held on the MID. It is vital that the MID holds your
correct registration number. If it is incorrectly shown on the MID you are at risk of having your vehicle seized by the Police. You can check that your correct registration number details are shown on the
MID at [Link]

PROCEDURE IN THE EVENT OF A COMPLAINT

Sabre Insurance Company Ltd is a member of the Financial Ombudsman Service scheme for complaints from private policyholders. Should you have a complaint, please write to Go Girl at Sabre Insurance
Company Ltd. Full details of our complaints procedure is available on our website ([Link]) and will be set out in your policy booklet or write to Go Girl at Sabre Insurance Company Ltd. The
address is Sabre House, 150 South Street, Dorking, Surrey, RH4 2YY. The complaints procedure does not affect your right to take legal action.

CHANGE OF INSURANCE
If you require an alteration to your policy for one of the following reasons i.e. change of vehicle, additional vehicle, amended drivers or use, please notify Go Girl immediately.

DECLARATION: I declare that to the best of my knowledge and belief all the above statements are true and complete.
I understand that reasonable care should be taken when answering all questions at the inception of this contract. I understand that I must notify immediately any changes to the information
provided herein and I understand that failure to do so means that the policy may not operate to protect me. I will take reasonable care to ensure any changes to the information provided herein
are declared along with any other facts which may influence the acceptance and assessment of the company’s renewal terms. I understand that you will pass the information on this form and
about any incident I may give details of, to the MIB so that they can make it available to other insurers. I also understand that, in response to any searches you may make in connection with
this application or any incident I have given details of, MIB may pass on to you information it has received from other insurers about other incidents involving anyone insured to drive the
vehicle covered under the policy.

I agree that this statement and declaration shall form the basis of the contract between me and the insurer and that if any answer has been written by any other person, such person shall be
deemed to be my agent for that purpose.

Sabre Insurance Company Limited, Sabre House, 150 South Street, Dorking, Surrey, RH4 2YY. Reg. No. 2387080
Claims Tel: 0330 024 8050 website: [Link] email: claims@[Link]
Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority
Member of the Financial Ombudsman Service and the Association of British Insurers
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