34545323455index,1

3478676865245-0000000
34545323455output_folder,/tmp/assentis/2354565313:126008aa-5ef2-4c2d-ae94-3ff9ecefcf57
34545323455persist,true34545323456
34545323455document_name,c122da71-50da-4d2d-91e5-d6250b399c57A_HWPCXSOF
34545323455tray1,
34545323455printfile_path,/tmp/assentis/2354565313:126008aa-5ef2-4c2d-ae94-3ff9ecefcf57/3b680f3f-7afd-4543-a950-b95fcd247edcPACK.pdf34545323456
34545323455tray2,
34545323455tray3,
34545323455tray4,
34545323455tray5,
34545323455tray6,
34545323456
34545323456 34545323456
34545323456

j. Your abode must not be any of the following; Squat, Static

Statement of fact - Allianz Private Car
Caravan, Caravan, Barge, House Boat or No fixed
Important - Please read carefully Abode/address.
This Statement of Fact is a record of information given by you k. Have no additional employment or occupation outside of
which has been used to assess the risk and decide terms and that disclosed for the purposes of obtaining this insurance.
conditions for your contract of insurance. You must check this l. That holds a Full UK Driving Licence and is aged between
document and tell us straight away if any of the information is 18 and 20 years of age is prohibited from carrying
incorrect or incomplete. Failure to do this may mean that your passengers in the insured vehicle.
policy becomes invalid or does not operate in the event of a claim 2. I declare that the vehicle:
or that you may experience difficulty getting insurance or need to
a. Will only be used by the policy holder and named driver;
pay extra premium in the future. Any amendment to your
information may change your terms or conditions or mean that b. Will only be used for social, domestic and pleasure purposes
or in person by you in connection with your business;
we may no longer be able to offer cover.
c. Will not be used for any purpose in connection with the
Driver details - Main driver: motor trade or use for hire and reward, racing, pacemaking,
Name: Mr Eyituoyo Idundun Tony speed testing,
competition, rallies, trials or track days or use on the
Email Address: idunduntony361@[Link]
Nürburgring Nordschleife;
Phone: 07444803627
d. Is not impounded by the police;
Address 1: 1 Apartment 5
e. Is 25 years old or less from the date of first registration;
Address 2: James Pimlott Drive, SK12 1FD
f. Will not be used to carry hazardous, corrosive or explosive
DOB: 20/04/1980 goods;
Occupation: Security Officer
g. Has not been modified apart from modifications for disabled
Licence Type: Provisional UK drivers and has no more than 7 seats in total and is
Country of Issue: UK right-hand drive only and has a valid MOT certificate (if
Length of Licence: 1 Year required) and has not been recorded as a Category A or B
insurance total loss and is not a Q plated vehicle;
Vehicle details: h. Is registered in Great Britain, Northern Ireland or the Isle
of Man;
Registration: SC08WUB
i. Will be in the UK at the start of the policy and will not be
Make: MAZDA exported from the UK during the duration of the policy;
Model: 3 TAKARA j. Has a current market value not exceeding £65,000. For
Cover: Comprehensive drivers under 25 years of age this is limited to £50,000. The
Reason for Cover: Learning to Drive in your own Car minimum vehicle value is £500.
Duration: 14 Days 3. I am aware that this temporary insurance policy cannot be
Start Date: 01/05/2025 used for Hire or Loan Vehicles (i.e. Vehicle Rentals, Vehicle
Salvage or Recovery Agents, Credit Hire Vehicles or
Start Time: 00:30 Companies and Accident Management Companies).
4. I declare that the Certificate of Motor Insurance and any
Allianz Private Car - Short Term Insurance Declaration other document will not be used as evidence of insurance
This is a copy of the declaration that you have agreed to as part for the release of a vehicle impounded or confiscated by
of purchasing insurance from GoShorty you have agreed that you the Police or Local Authority.
meet the following Assumptions and Eligibility Criteria. Failure to 5. I am aware that this policy has a minimum excess in respect
meet the Assumptions and Eligibility Criteria could invalidate your of Accidental Damage, Malicious Damage, Fire and Theft
[Link] must make sure that you continue to fit this criteria claims of £500.
at all times. 6. I am aware that the driving of other cars is not permitted
1. I declare that I and any named driver: under this policy.
a. Are aged between 17 and 75 years of age; 7. I am aware that no amendments, alterations or changes
can be made to this policy or Certificate of Motor Insurance
b. Hold a Full United Kingdom driving licence, Full EU or Full once issued.
EEA Driver's License, or a United Kingdom Provisional 8. I have read and agree that the above conditions are met
Drivers licence; and that I have taken reasonable care not to make any
c. That holds an EU Driving Licence must be a current UK misrepresentation of the information I have provided.
resident, with a minimum length of residency of 12
consecutive months in the 1 year prior to inception;
d. Are not aware of any pending prosecution or Police enquiry
pending for any motoring offences;
e. Have no more than 6 penalty points on their driving licence
following motoring convictions;
f. Have not had any of the following conviction codes DR,
CD, DD, UT & DG or have any motoring conviction that has
a driving ban in the last 5 years;
g. Have had no more than 1 claim in the last 3 years,
regardless of fault.
h. Do not have any unspent criminal convictions (other than
motoring offences that are acceptable on the scheme) or
police cautions in the last 5 years;
i. Have not had a motor insurance policy cancelled, voided,
refused or had a premium increase;

GoShorty is a trading style of Complex to Clear Group Limited registered in England and Wales.
Company Registration Number 05044963. Data Protection Registration ZA456686.
Authorised and regulated by the Financial Conduct Authority under reference 751221.