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47074522/001/1.01/T5 - 11:55 28\06\2024

Tesco Bank Car Insurance - Statement of Fact

Policy Number 9052035N Cover Start Date 17/07/2024
1. YOUR DETAILS
Full names of Policyholder Mrs Lynsey Brennan Post Code of where Vehicle Kept As Address
Address of Policyholder 41 Braefoot Avenue Where is the vehicle kept overnight? Driveway
Milngavie
GLASGOW
G62 6JS

2. CAR DETAILS
Right Hand Engine Year of Est Annual 8 seats or Year of Registration
Make & Model (state if GL, GTi etc.) Drive Size Purchase Mileage less Registration Number
ALFA ROMEO MITO DISTINCTIVE JTDM-2 (120) Yes 1598 2018 3000 Yes 2011 SO11DKF
Fuel Diesel Transmission Manual
You/your husband or wife/civil partner/partner owns the car Yes If 'no' details given
You/your husband or wife/civil partner/partner is the registered keeper of the car Yes If 'no' details given
The vehicle has been adapted, altered or modified from the manufacturers original No If 'yes' details given
specification that alters its performance (such as engine or exhaust modifications or changes)
or appearance (such as bodykits, spoilers, alloy wheels, lowered suspension or blacked
out windows), other than manufacturer options fitted to the car from new or adaptions made
purely for disabled use (such as hand controls and wheelchair access)

3. COVER REQUIRED
Comprehensive Yes Voluntary Excess £150 TPFT TPO

4. USE REQUIRED (see overleaf for details of use or ask Tesco Bank)
Social domestic & pleasure Social domestic & pleasure Class One Yes Class Two Class Three
including commuting excluding commuting

5. NO CLAIMS DISCOUNT DETAILS

Number of years No Claims Discount 4 No Claims Discount protected No

6. DRIVERS REQUIRED
Yourself only You & the driver(s) named below Yes
Driver 1 (You) Driver 2 Driver 3 Driver 4 Driver 5
Mr Stephen
Driver's Name as above
Brennan

State MALE or FEMALE Female Male

Marital Status Married Married

Relationship to Driver 1 (You) N/A Spouse

Age 46 47

Occupation - Full Time Minister Of Religion Software Engineer

Type of Business Church Information Technology

Type of licence held (Full UK etc) Full UK Full UK

Number of years licence held 4 Years 20 years

Date from which the driver has been resident in the UK 27Aug1977 20Feb1977
The Driver will use the vehicle for commuting Yes Yes

The Driver is the main user Yes No

The Driver has access to any other vehicle Named Driver Owner

The Driver has ever had an insurance policy cancelled

or made void by a previous insurer for any reason, No No
including missed payments
The Driver has been involved in any accidents, had a No No
car stolen or had any fire, theft, vandalism, flood or
glass damage relating to any motor vehicle within the
last 5 years, regardless of fault or whether a claim was
made or not If 'Yes', give details in 7 on Page 2 If 'Yes', give details in 7 on Page 2
The Driver has been convicted of any motoring offences No No
or had any driving licence endorsements or fixed
penalties within the past 5 years If 'Yes', give details in 8 on Page 2 If 'Yes', give details in 8 on Page 2
The Driver has been convicted of any non-motoring
No No
offences

The Driver has informed DVLA of any notifiable medical

Yes Yes
conditions and they have agreed to issue a licence

Tesco Bank Car Insurance and optional add-on insurance products are arranged and administered by Tesco Bank acting as an insurance intermediary. Tesco Bank Car Insurance is underwritten by Tesco Underwriting Ltd., The
Omnibus Building, Lesbourne Road, Reigate, Surrey, RH2 7LD.
Optional add-on products are underwritten by the insurers set out in the Additional Cover section of the Schedule.
Tesco Bank is a trading name of Tesco Personal Finance plc. Registered in Scotland No. 173199. Registered Office: 2 South Gyle Crescent, Edinburgh EH12 9FQ.
Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.
We may monitor and record calls for training purposes, to improve the quality of our service and to detect and prevent fraud.
7. ACCIDENTS, CLAIMS OR LOSSES
Driver's Name Date of Incident Brief details of what happened At fault?
NONE

8. CONVICTIONS, ENDORSEMENTS AND FIXED PENALTIES

Driver's Name Conviction Date Offence Code (see licence) Length of any disqualification
NONE

Important Notes
It is essential that you read the information above and on the previous page as it represents a record of your answers to our questions. You must advise
Tesco Bank immediately if any of the information is incorrect or is missing - failure to do so may affect whether you can make a claim or invalidate your
policy altogether. You must also let Tesco Bank know immediately if any of the information above or on the previous page changes during the term of your
policy. You will be advised of any change to your premium or the terms we require. This document should be stored securely and read in conjunction with
your Policy Booklet, Policy Schedule and Certificate of Motor Insurance. These words have a particular meaning: "us", "our" and "we" mean Tesco
Underwriting.
False statements, misrepresentation or withholding information
Making a false statement or misrepresenting or withholding information from the administrator could result in your contract of insurance being voided (as
if the policy never existed), all claims under your policy being refused and all premiums that you have paid being retained. It is your responsibility to ensure
that all the information that has been given by you, or that has been given on your behalf, is true and complete. If there are any errors on your Statement
of Fact, Schedule or Certificate of Motor Insurance or the information is not correct your policy may be voided.
Please contact our Customer Services Line immediately if you are in any doubt that your policy details are not correct to ensure you, and any other driver
covered by your policy, continue to have the full protection of your policy.
Insurance Registers and Databases
We may exchange information with the Police where this is needed to validate a claim.
We may share information which we hold and which has been supplied to us in connection with any application for insurance that you have made or any
insurance policy which you have with us (including the renewal of any policy which you have with us) with the Claims and Underwriting Exchange register,
run by the Insurance Database Service Limited (IDS Ltd) and other similar databases or fraud prevention agencies established for the same purpose.
The aim is to help us check information that is given to us and to prevent or detect crime, including fraud.
When we process your request for insurance cover, the terms on which cover may be offered, process claims and maintain your policy during the Period
of insurance, we may search these registers.
If you give inaccurate details or fraud is suspected or identified this may be shared with fraud prevention agencies, and may also be used by other organisations
to make decisions about you and others in your household on credit, insurance (including claims), debt tracing, and to prevent crime. If such companies
suspect fraud, we will share your relevant personal information with them. This information could be accessed and used by law enforcement agencies.
Under the conditions of your policy, you must tell us about any incident (such as an accident or theft), whether or not you think it is likely to give rise to a
claim.
When you tell us about an incident, we will pass information relating to that incident to these registers.
Information relating to your insurance policy will be added to the Motor Insurance Database (MID) managed by the Motor Insurers' Bureau (MIB). The 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: I. Electronic Licensing II. Continuous Insurance Enforcement, III. Law enforcement
(prevention, detection, apprehension and or prosecution of offenders), IV. 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), the insurers
and/or the MIB may search the MID to obtain relevant information. Persons (including his or her 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 find out more about
the MID at [Link] and you can check that your correct registration number details are shown on the MID at [Link]
Credit Searches and use of Third Party Information
In assessing your application/renewal, to prevent fraud, check your identity and to maintain its policy records, the insurer may:
• Search files made available to it by credit reference agencies who may keep a record of that search. The insurer may also pass to credit reference
agencies information it holds about you and your payment record. The information will be used by other credit lenders for making credit decisions about
you and the people with whom you are financially associated for fraud prevention, money laundering prevention and for tracing debtors.
• Use information relating to you and your vehicle supplied to us by other third parties.

USE REQUIRED - Your selection is shown in Section 4

Please ensure you choose the correct option. If you need further help please ask.
Social Domestic & Pleasure including commuting
Use for social, domestic and pleasure purposes including commuting. EXCLUDING use for any business purpose, any purpose in connection with the motor trade, carriage of passengers or goods for hire
or reward, or for hiring, racing, competitions, rallies, trials, pace-making or speed testing.
Social Domestic & Pleasure excluding commuting
Use for social and pleasure purposes. EXCLUDING use for commuting, any business purpose, any purpose in connection with the motor trade, carriage of passengers or goods for hire or reward, or for
hiring, racing, competitions, rallies, trials, pace-making or speed testing.
Class 1 Business Use
Use for social, domestic and pleasure purposes and by the Policyholder and Policyholder's husband/wife/civil partner/partner, each in person in connection with their business or profession. EXCLUDING
use for commercial travelling, any purpose in connection with the motor trade, carriage of passengers or goods for hire or reward, or for hiring, racing, competitions, rallies, trials, pace-making or speed
testing.
Class 2 Use
Use for social, domestic and pleasure purposes and for the business of the Policyholder and the Policyholder's employer. EXCLUDING use for commercial travelling, any purpose in connection with the
motor trade, carriage of passengers or goods for hire or reward, or for hiring, racing, competitions, rallies, trials, pace-making or speed testing.
Class 3 Use
Use for social, domestic and pleasure purposes and for the Policyholder's business. EXCLUDING use for any purpose in connection with the motor trade, carriage of passengers or goods for hire or reward,
or for hiring, racing, competitions, rallies, trials, pace-making or speed testing.