<root node><cpdPolicyNumber>373005598</cpdPolicyNumber><ampFullname>Mr Raymond Law</ ampFull name><ampTitl e_Sur name>Mr Law</ ampTitle_Sur name><cipForename>Raymond</ci pFor ename><cpdAg entDebug>Sterli ng Insur

r ance Ser vices</cpdAgentDebug><ampAgentRef erence>8001</ ampAgentRef erence><derOper at or>Kier an George</derOperat or><ampAgent _EMail>contact-us@adrianfl ux.co. uk</ ampAgent _EMail><ampAgent _Web>www. adrianflux.co. uk</ ampAgent _Web><ampAg ent _PhoneNo>0844 888 5544</ampAg ent_PhoneNo><cpdPolicyType>24</ cpdPolicyType><cpdSchemeTableID>1449</cpdSchemeTableID><ampEcomailBr andi ng>18PLUS</ ampEcomailBrandi ng><cpdSourceBusinessDebug>For d Capri
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Part of Adrian Flux Insurance Services, an Independent Intermediary, Authorised and regulated by the Financial Services Authority No 307071
Partners: D. Flux and Y. Flux. Consumer Credit Licence No. 535428





Customer Ref No: 373005598/16






Mr Raymond Law
20, The Limes
Erdington
BIRMINGHAM
W Midlands
B24 8AF



Date: 05/11/2012

Dear Mr Law

We thank you for your instructions and payment of 206.00 and have pleasure in
enclosing our Terms of Business together with your Cover Note/Certificate and
Statement of Fact (which is the basis of the insurance contract). Please ensure that
all details are checked carefully and any discrepancies advised to us immediately.

Documents To Be Returned (A full description of these items is shown overleaf)
Supplementary Questionnaire
Limited Mileage Declaration Form
Agreed Value Form
Seven Recent Colour Photographs of your Vehicle

Please note that it is very important that the above are received within 14 days to
enable us to finalise the policy on your behalf. Please remember, if you are sending
your driving licence(s) to us then please do not send the original as we cannot
accept responsibility if it goes missing or gets damaged whilst in transit. Please
always send us photocopies.


Please Note: The price shown on the attached Schedule is the basic insurer
premium, without any fees or additional policies.


If you have any queries please do not hesitate to contact us.

Yours sincerely


Kieran George


















Policy Summary

Registration/Chassis No.
D760 BFP

Cover
Comprehensive

Renewal Date
05/11/2013

Insurance Company
Equity Red Star

Policy Number
34626810

Claims Helpline
0844 888 7360









Adrian Flux Insurance Services
East Winch Hall. East Winch, King's Lynn,
PE32 1HN



Contact

Weekdays 9:00am - 5:30pm
Saturday 9:00am - 1:00pm

t: 0844 888 5544
f: 0844 888 0101
e: contact-us@adrianflux.co.uk
w: www.adrianflux.co.uk



Got a question? Visit our
website FAQs to see if we've got
the answer.

www.adrianflux.co.uk
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Part of Adrian Flux Insurance Services, an Independent Intermediary, Authorised and regulated by the Financial Services Authority No 307071
Partners: D. Flux and Y. Flux. Consumer Credit Licence No. 535428
Client Ref : 373005598

ADDITIONAL INFORMATION REQUIRED WITHIN 14 DAYS

Limited Mileage Declaration Form
This should be completed with the mileage reading at the inception of the policy.

Agreed Value Form
This should be completed and returned along with any photographs specified below if the option of an agreed
value is required. Should your vehicle be a total loss following a claim, your insurers will pay the value you have
specified for your vehicle, less the relevant excess, subject to you providing the requested documentation and
the value being agreed by us and your insurers.
A payment of 15.00 will also be required.

Seven Recent Colour Photographs of your Vehicle
These need to consist of photographs of your vehicle taken square on showing the front, back, each side,
engine bay, mileometer and interior, with one including the registration number. Unfortunately, Polaroid
photographs are unacceptable , but digital photographs are acceptable and if preferred can be sent to us on
CD/DVD (Please note that we are unable to return any photographs). If these and the required valuation are not
received, then your policy will be processed on a market value, until such time that we are in receipt of the
required documentation. Examples of acceptable and unacceptable photos can be found in the Existing Client
section of our website under the 'Paperwork' link.






STATEMENT OF DEMANDS AND NEEDS

This policy is suitable for you based on the information you gave us as per the attached Statement of Fact and
your requirement for a competitive premium. We are dealing with this transaction on a non-advised basis.




Policy Wording

The details of your motor insurance policy are attached below for reference. Simply follow the link to download the full
policy booklet. :

http://www.adrianflux.co.uk/pdfs/documents/EQUITY_RED_STAR_Private_Car_2012_01.pdf


Your Selected Additional Benefits

Motor Legal Protection

We have included up to 100,000 worth of legal assistance free of charge.

Follow the link below to download the policy booklet.

http://www.adrianflux.co.uk/pdfs/documents/ULR_Legal_Adrian_Flux_2012_02.pdf


Trinity Lane Personal Accident Cover

Please note: Premiums will not be refunded if this policy is cancelled after 14 days of commencement.

To download the policy booklet follow the link below:

http://www.adrianflux.co.uk/pdfs/documents/TL_Auto_Extra_PV_2010_11.pdf


Flux Rescue (Breakdown)

Please note you will not be covered for the first 24 hours after taking out this policy. The premium for this policy will not be
refunded if it is cancelled after 14 days of commencement.

To download the policy booklet follow the link below.

http://www.adrianflux.co.uk/pdfs/documents/EQUITY_RED_STAR_Flux_Rescue_Breakdown_2009_09.pdf


Keycare Cover

Please note: Premiums will not be refunded if this policy is cancelled after 14 days of commencement.

To download the policy booklet follow the link below.

http://www.adrianflux.co.uk/pdfs/documents/GROUPAMA_Key_Care_2010_07.pdf





TERMS OF BUSINESS

Adrian Flux Insurance Services, East Winch Hall, East Winch, Kings Lynn, Norfolk, PE32 1HN
Telephone 0844 888 5544 Fax 0844 888 0101

The Financial Services Authority (FSA)
The FSA is the independent watchdog that regulates financial services. Please use this document to decide if our services are right for you.

Our Service
We act as an Independent Broker on your behalf. You will not receive advice or a recommendation from us and you will need to make your own choice with
regard to the products that we offer you. Our service includes administrating the policy for you and helping you with any ongoing changes you have to make.

Who regulates us?
Adrian Flux Insurance Services is authorised and regulated by the Financial Services Authority. Our FSA Register number is 307071. Adrian Flux is also licensed
by the Jersey and Guernsey Financial Services Commissions.

Our permitted business is:

Arranging (bringing about) deals in non-investment insurance contracts
This covers a range of activities including introducing a customer to an insurer, helping a customer to complete a proposal form and sending this to an insurer.

Making arrangements with a view to transactions in non-investment insurance contracts
This includes helping a potential policyholder to complete a proposal form or introducing a customer to another intermediary, either for advice or to help arrange
an insurance policy.

Dealing as agent in non-investment insurance contracts
This includes entering into a contract of insurance with a customer on behalf of an insurer (for example, issuing a cover note).

Assisting in the administration and performance of a non-investment insurance contract
This includes notifying an insurance claim to the insurer and negotiating settlement on behalf of the customer. You can check this on the FSAs register by
visiting their website www.fsa.gov.uk/register or by contacting them on 0845 606 1234.

Products which we offer
We sell a wide range of both personal and commercial insurance products and provide information on the basis of a fair analysis of the market from a wide range
of insurers. Please note that any additional policies we sell in conjunction with your main policy are linked and will be cancelled in line with the main one. We only
offer products from a limited number of insurers for caravan insurance. We will provide a list of these insurers on request.

For Legal Expenses Insurance we deal exclusively with Ageas Insurance Limited.
For Replacement Car Cover we deal exclusively with Ageas Insurance Limited.
For Roadside Assistance Cover, we deal exclusively with Equity Red Star.
For Personal Accident, Helmet & Leathers Insurance & Mobility Scooter Insurance we deal exclusively with Trinity Lane.
For Key Care Insurance, we deal exclusively with Groupama Insurance Company Ltd.
For Misfuel Insurance, we deal exclusively with Sterling Insurance.
For Third Party Fire and Theft Windscreen Cover we deal exclusively with Markerstudy Limited.
For Driverguard Insurance we deal exclusively with Isle of Man Assurance.
For Excess Protection and Gadget Cover Insurance we deal exclusively with Ageas Insurance Limited.
For Travel Insurance we deal exclusively with Axa-Sun World Travel.
For Independent Living Insurance we deal exclusively with Groupama.
For Family Personal Accident Insurance we deal exclusively with Novae.
For Household legal cover we deal exclusively with UK Underwriting Ltd.
For Household Home Emergency we deal exclusively with Europ Assistance

Trinity Lane Insurance Company Ltd is owned by one of the Partners of Adrian Flux Insurance Services.

Our Charges: In addition to premiums charged by Insurers, we normally make the following charges to cover the administration of your insurances:

25 Making mid term amendments, arranging collection of bad debts with our debt collection agency, processing cheques which are returned by our bank
as un-cleared, cancellation of policies and setting up of Finance Agreements.
35 If we identify discrepancies and/or non-disclosures which do not correspond to the information you have provided when you purchased your policy we
will apply the correct additional premium plus the 35.00 administration fee.
30 For setting up new policies, renewing a policy (non refundable)
15 For arranging an agreed value and sending call recordings.

If the policy is underwritten by Trinity Lane Insurance Co. Ltd. then a percentage fee based on the insurers premium will be applied to the policy in addition to
those listed above.
Please note that your insurer may make a charge of 20.00 for any amendment made to your policy in addition to any increase in premium and our mid term
adjustment fee.

Return premiums (usually arising if an insurance risk is reduced or the policy is cancelled), will be refunded to you net of commission (or percentage based fee if
insured through Trinity Lane Insurance Co. Ltd). which could be up to 30%. Where applicable, all refunds will be processed to the same credit / debit card that
was used to make a payment on the policy.

If you take a new policy out with ourselves and make a payment towards this new policy but have a previous policy with ourselves that has an outstanding balance
we reserve the right to transfer any money paid on the new policy to cover the debt outstanding on your previous policy.

How monies paid to us are handled
We are the Agent of Insurers for the purpose of collection of premiums and refunds of premiums. This means that premiums are treated as being received by the
Insurer when received in our bank account, and that any premium refund is treated as received by you when it is actually paid over to you. We normally accept
payment by guaranteed cheque or any of the major debit/credit cards.

We will retain your debit/credit card details for the purposes of automatic renewals and to pay or refund other premiums that may become due upon changes to
the policy.

Cancellations
If you wish to cancel your policy, you must first call our customer service team. DO NOT CANCEL YOUR DIRECT DEBIT PAYMENTS. You may be due a refund
for part of your premium as long as no claims have occurred during your time on cover. You must return your certificate of insurance or a lost certificate
declaration together with a letter confirming your cancellation request before we can cancel your policy.

Upon cancellation of the contract, it should be noted that Insurance companies apply short term cancellation charges which are not proportionate to the annual
premium and as these form part of the contract offered, we would ask clients to realise that such charges upon cancellation are applied by the underwriters and
not ourselves
Please note the premiums paid for supplementary covers are not refundable following cancellation.



Premiums and Financial Aspects
In order to be able to offer you credit facilities, we are registered under the Consumer Credit Act and our Licence Number is 535428. You may be able to spread
your payments through insurers instalment schemes or a credit scheme that we have arranged with a third party finance provider. We will give you full information
about your payment options when we discuss your insurance in detail.

Please note that this is a Finance Agreement between yourself as the policyholder and Premium Credit, and is separate to the Insurance Policy. As this is in
effect a loan for the initial premium, this agreement MUST NOT be cancelled until this has been fully repaid to the Finance Company, even if your Insurance
Policy has been cancelled. If any direct debit or other payment due in respect of the credit agreement you enter into with Premium Credit Limited (PCL) to pay
insurance premiums is not met when presented for payment, or if you end the credit agreement with PCL, or if you do not enter into a credit agreement with PCL
we will be informed of such events by PCL.

If you do not make other arrangements with us to pay the insurance premiums you acknowledge and agree that we may, at any time after being so informed,
instruct on your behalf the relevant insurer to cancel the insurance (or, if this occurs shortly after the start or renewal of the insurance, to notify the insurer that the
policy has not been taken up) and to collect any refund of premiums which may be made by the insurer and if any money is owed to PCL under your credit
agreement pay it to PCL or if PCL have debited us with the amount outstanding use it to offset our costs. The balance will be debited from the debit/credit card
last used by yourself.

You will be responsible for paying any time on risk charge and putting in place any alternative insurance and/or payment arrangements you need.

If during the course of the policy any additional premiums or refunds of premium are due, then these will be automatically applied to the remaining balance on the
Premium Credit account.

For the purposes of introducing customers to premium finance facilities we deal exclusively with Premium Credit Limited.

Disclosure
It is your responsibility to provide complete and accurate information to insurers when you take out your insurance policy, throughout the life of your policy and
when you renew your insurance. It is important you ensure that all information, statements or answers made by you to us or on proposal forms, claim forms and
other documents are full and accurate and must be correct. If a form is completed on your behalf, you should check that the answers shown to any questions are
true and accurate before signing the document.

Your attention is particularly drawn to the importance of the declaration and signature on Insurers Proposal Forms as any failure to disclose facts material to the
insurance or any inaccuracies in your answers may invalidate your insurance cover in part or in whole. Facts material to the insurance are matters of information
which may influence your Insurer as to the acceptability or otherwise of your Proposal or Renewal and must be disclosed at the earliest opportunity, and certainly
at renewal. You are reminded that it is an offence under the Road Traffic Act to make any false statements or withhold any relevant information to obtain an
Insurance Certificate. You are advised to keep copies of any correspondence you send to us or direct to your insurer. Please do consult us if you are in doubt on
any aspect.

If you are in any doubt as to whether any information is material, you should disclose it.

Awareness of Policy Terms
When a policy is issued, you are strongly advised to read it carefully as it is that document, the schedule, any certificate of insurance and the policy wording, which
is the basis of the insurance contract you have purchased. If you are in any doubt over any of the policy terms or conditions, please seek our advice promptly.

Claims
If you are involved in an accident or have occasion to claim on your policy for any other reason, you must notify us immediately and we will promptly advise you
and, if appropriate, issue you with a claim form and pass details to your Insurer. You should not admit liability or agree to any course of action, other than
emergency measures to minimise your loss, until you have agreement from your insurer. You must continue to make your monthly payments for your insurance, if
applicable. We reserve the right to withhold payment in respect of claims, if payment of any premiums to ourselves is in default.

Automatic Renewals
For your protection, we reserve the right to automatically renew your policy up to 5 days prior to the renewal date and take payment by the same payment method
as this year. If we exercise this right we will write to you prior to renewal date, advising you how much the premium will be and giving you time to contact us and
advise us if you wish to opt out of the automatic renewal process. We also reserve the right to automatically renew any additional policies that you take out with
this policy, such as breakdown assistance cover.

Complaints
It is our intention to provide you with a high level of customer service at all times. However, if, at any time you are dissatisfied with the service we provide, we
have a formal complaints procedure, a copy of which is available upon request. Alternatively, in the first instance please call one of our Clerks or write to us. We
expect that they will be able to resolve the issue for you, but if you remain dissatisfied we will advise you of how to take the matter further. If we cannot settle your
complaint, you may be able to refer it to the Financial Ombudsman Service. We will advise you if you are able to refer any complaint to the Financial
Ombudsman.

Financial Services Compensation Scheme (FSCS)
We are covered by the FSCS. You may be entitled to compensation from the scheme if we cannot meet our obligations. This depends on the type of business and
the circumstances of the claim. Insurance advising and arranging is covered for 90% of the claim, without any upper limit. For compulsory classes of insurance,
insurance advising and arranging is covered for 100% of the claim, without any upper limit. Holders of policies issued by IOMA will not be protected by the United
Kingdom Financial Services Compensation Scheme if IOMA should become unable to meet its liabilities. Further information about compensation scheme
arrangements is available from the FSCS.

Confidentiality
All personal information about our customers is treated as Private and Confidential.

We will only disclose the information we have about private individuals in the normal course of arranging and administering their insurance and will not disclose
any information to any other parties without their written consent unless required by law or public interest. We may use the information we hold about our
customers to provide them with information about other products and services which we feel may be appropriate to them. Under the Data Protection Act 1988,
private customers have a right to see the personal information about them that we hold in our records. If you wish to exercise this right, or have any other related
queries, you should write to Mr P Twite at the address enclosed.

Claims and Underwriting Exchange Register and Motor Insurance Anti-Fraud Register
Insurers pass information to the Claims and Underwriting Exchange Register operated by Database Services Ltd and the Motor Insurance Anti-Fraud Register
compiled by the Association of British Insurers. The aim is to check information provided and to prevent fraudulent claims.

Motor insurance details are also added to the Motor insurance database operated by the Motor Insurers, Information Centre (MIIC), which has been formed to
help identify uninsured drivers and may be searched by the Police to help confirm who is insured to drive. In the event of an accident, this database may be used
by Insurers, MIIC and the Motor Insurance Bureau to identify relevant policy information. Other insurance related databases may also be added in the future.

Identity and Credit Searches
We, and the Companies we place business with, may make searches about you at credit reference agencies who will supply us with information, including
the Electoral Register and credit information. The agencies will record details of the search whether or not your application proceeds. The searches will not be
seen or used by lenders to assess your ability to obtain credit. We may use scoring methods to assess this application and to verify your identity. Credit searches


and other information which is provided to us and/ or the credit reference agencies, about you and those with whom you are linked financially, may be used by
Adrian Flux Insurance and other companies if you, or other members of your household, apply for other facilities including insurance applications and claims. This
information may also be used for debt tracing and the prevention of money laundering as well as the management of your account. Alternatively, we may ask you
to provide physical forms of identification.

Note - Your acceptance of these Terms of Business does not affect your normal legal rights.

English Law
This insurance is written in English and all communications about it will be in English. Unless we have agreed otherwise with you, this contract is governed by
English law.

Equity Red Star is managed by Equity Syndicate Management Limited which is authorised and regulated by the Financial Services Authority. Equity Syndicate
Management Limited is Registered in England and Wales No. 426475. Registered Office: Library House, New Road, Brentwood, Essex CM14 4GD.
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P


CERTIFICATE OF MOTOR INSURANCE

Certificate No. 34626810
1. Registration of vehicles.
D760 BFP

2. Policyholder. Mr Raymond Law

3. Effective date of the commencement of insurance
for the purpose of the relevant law. 05/11/2012 14:56:00

4. Date of the expiry of insurance. 04/11/2013 23:59:00

5. Persons or classes of persons entitled to drive.
The Policyholder and his/her husband or wife only






Provided that the person driving holds a licence to drive the vehicle or has held and is not
disqualified for or prohibited by law from holding or obtaining such a licence.

6. Limitations as to use.
Use only for social, domestic and pleasure purposes including travelling to and from a
permanent place of work/business but excluding use for the purpose of any profession, trade,
business, employment, despatch, courier, messenger or food delivery services.

Where the driving other vehicles extension is shown under section 5 of this certificate of
insurance this policy does not cover use to secure the release of a motor vehicle, not otherwise
specifically the subject of insurance by this policy, which has been seized by, or on behalf of,
any government or public authority

The policy does not cover use of hiring, the letting on hire, the carriage of passengers or goods
for hire or reward, racing, pacemaking, use in any contest, reliability or speed trial, or use for
any purpose in connection with the motor trade, except where included in 6 above.





















































IMPORTANT
THESE NOTES ARE
FOR YOUR GUIDANCE

If the wording of this certificate
includes the driving of another
vehicle, this will be shown in the
'Persons or classes of person
entitled to drive' section of this
certificate and cover in respect of
any vehicle covered under the
extension will be for THIRD
PARTY risks only. If this is not
shown within that section, then
you do not have the cover.
To ensure full protection under
your policy it is essential to notify
your broker of any change to the
details previously supplied such
as:
(a) Change of address,
occupation, vehicle(s) declared or
use of your car/vehicle.

(b) The drivers covered
(especially the inclusion of any
person under 25 years of age.)

(c) Motoring convictions and/ or
summons pending/accidents/
physical condition of any person
likely to drive.
WARNING
If any person for the purpose of
obtaining the grant of any licence
to himself/herself of any other
person knowingly makes any false
statement, or for the purpose of
obtaining the issue of a certificate
of insurance or of a certificate of
security under the relevant law
applicable in Great Britain,
Northern Ireland, the Isle of Man,
the Island of Guernsey, the Island
of Jersey and the Island of
Alderney, makes any false
statement or withholds any
material information, he/she shall
be liable to a fine not exceeding
fifty pounds or to imprisonment
for a term not exceeding six
months or to both such
imprisonment and fine.
I hereby certify that the policy to which this certificate relates satisfies the requirements of the relevant
law applicable in Great Britain, Northern Ireland, the Isle of Man, the Island of Guernsey, the Island of
Jersey and the Island of Alderney.

For and on behalf of the Underwriters subscribing to EQUITY RED STAR, Library House, PO Box 218,
Brentwood, Essex CM14 9AZ.
Authorised Insurers

Mark Bacon
Underwriter
Note: For full details of the insurance cover reference should be made to the policy.

ADVICE TO THIRD PARTIES - NOTHING CONTAINED IN THIS CERTIFICATE AFFECTS YOUR RIGHTS AS A THIRD
PARTY TO MAKE A CLAIM.

European Union (EU) (Compulsory Cover)
This Certificate of Motor Insurance is evidence that the insurance extends to the compulsory motor insurance requirements of the following.
a. any member of the European Union
b. Croatia, Iceland, Norway, Andorra and Switzerland (including Liechtenstein).

Ce certificate dassurance automobile tmoigne dun contrat dassurance mis en conformit avec les exigencies dassurance obligatoire de vhicules moteur de
a. tout pays member de lUnion Europenne
b. la Croatie, lIslande, la Norvge, lAdorre et de la Suisse (y compris le Liechtenstein)

Dieser Kfz.-Versicherungsbesttigung bildet den Nachweis dafr, dass diese Versicherung die Erfordernisse der obligatorischen Motorfahrzeugversicherungsgesetze in den folgenden
Lndern erfllt
a. alle Mitgliedstaaten der Europischen Union
b. Kroatien, Island, Norwegen, Andorra und die Schweiz (einschliesslich Liechtenstein)

Este certificado de Seguro de automviles testimonia una pliza de seguro emitida en conformidad con las leyes de seguro obligatorio en relacin con el uso de vehculos automviles de
a. todos los pases miembros de la Unin Europea
b. Croacia, Islandia, Noruega, Andorra y Suiza (incluido Liechtenstein)

Questo certificate di assicurazione di veilcoli a motore sta a comprovare una polizza di assicurazione emessa in conformit con le leggi della responsabilit obbligatoria relative alluso di
automezzi di
a. tutti I paesi membri dellUnione Europea
b. Croazia, Islanda, Norvegia, Andorra e Svizzera (incluso Liechtenstein)

This certificate is only valid if it
bears a security coded background
identifying the registration mark
and Policyholders name.
If you wish to cancel the policy you
must return the certificate. If this
certificate refers to a specific vehicle
and you are replacing your vehicle,
this certificate must be returned to
your broker.
THIS CERTIFICATE OF MOTOR INSURANCE HAS BEEN PREPARED ON A LASER
PRINTER AND IS NOT VALID IF IT HAS BEEN ALTERED IN ANY WAY.

W/S excess
90


Equity Red Star is managed by Equity Syndicate Management Limited which is authorised and regulated by the Financial Services Authority. Equity Syndicate Management
Limited is Registered in England No. 426475. Registered Office: Library House, New Road, Brentwood, Essex CM14 4GD.

20090101/1
EQUITY RED STAR
Library House, PO Box 218, Brentwood, Essex, CM14 9AZ.

SCHEDULE No: 05/11/2012

IMPORTANT: This endorsement appendix (which replaces any previous issue) forms part of the Insurance Document and applies in conjunction with
such Document, the current Certificate of Motor Insurance and schedule attached or previously applied.

Document No: 34626810 Period of insurance commencing: 05/11/2012 14:56:00
Expiring: 04/11/2013 23:59:00

Insured: Mr Raymond Law
20 The Limes
Erdington
BIRMINGHAM
W Midlands
B24 8AF

Occupation or Business: Factory Worker

INSURED VEHICLE(S)
Make and Model
Cubic
Capacity
Year Value Registration No
Cover
(as defined in the insurance Document)
FORD CAPRI INJECTION SPECIAL 2792 1987 2000 D760 BFP Comprehensive

ENDORSEMENT(S) APPLICABLE as indicated below (please refer to the insurance Document or endorsement appendix for full wording)
Endorsement Code Person(s) or class of person(s) and/or description
001 Damage, fire and theft excess
037 No claim bonus removed
297 Limited Mileage
438 Driving other cars excluded
821 Financial Services Compensation Scheme
936 LIMITED WINDSCREEN INDEMNITY
A51 Cancellation Clause Deletion
B14 B14 - windscreen damage


ANY ENDORSEMENT NUMBER SHOWN IN THIS SCHEDULE BUT NOT INCLUDED IN THE
ENDORSEMENT APPENDIX SHALL BE DEEMED TO APPLY AND FORM PART OF THE APPENDIX THE
ENDORSEMENT(S) BEARING SUCH NUMBER(S) BEING ATTACHED OR PREVIOUSLY APPLIED.

Excess Amount Excess Description
100 Accidental Damage Fire And Theft - Ungaraged vehicle
100 Accidental Damage Fire And Theft - Vehicle value
90 Windscreen Replacement Excess - Windscreen



REASON FOR ISSUE: New Business

BROKER: Sterling Insurance Services
SCHEME: Equity Red Star - 6430 Cult Car Scheme EDI


PREMIUM 103.77
INSURANCE TAX 6% 6.23
TOTAL PREMIUM 110.00
This premium is solely for the insurance policy, it does not
include any additional policies you may have purchased or any fees

Equity Red Star is managed by Equity Syndicate Management Limited which is authorised and regulated by the Financial Services Authority. Equity Syndicate Management
Limited is Registered in England No. 426475. Registered Office: Library House, New Road, Brentwood, Essex CM14 4GD.

20090101/1
EQUITY RED STAR
Library House, PO Box 218, Brentwood, Essex, CM14 9AZ.


IMPORTANT: This endorsement appendix (which replaces any previous issue) forms part of the Insurance Document and applies in conjunction with
such Document , the current Certificate of Motor Insurance and schedule attached or previously applied.

Document No: 34626810 Period of insurance commencing: 05/11/2012 14:56:00
Expiring: 04/11/2013 23:59:00

Insured: Mr Raymond Law
20 The Limes
Erdington
BIRMINGHAM
W Midlands
B24 8AF

Endorsement Number & Description and full wording (where applicable)
001
037
297 The mileage of your vehicle permitted during any one period of insurance will not exceed the mileage stated against this Endorsement
Number.
Mileage
438 This policy provides no cover for driving other cars.
821 The Financial Services Compensation Scheme information shown in the introduction to your policy document is deleted and replaced with
the following:
We are members of the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if we are
unable to meet our liabilities under this insurance. This depends on the type of business and the circumstances of the claim. A claim is
protected for 90% without any upper limit. For compulsory classes of insurance the claim will be met in full. Further information about the
compensation scheme arrangements is available from FSCS. Information can be obtained on request, or by visiting the FSCS website at
www.fscs.org.uk.
936 Our liability for windscreen damage under section 2 of this document will not exceed 1000. Any obligation you may have to make a
payment towards the replacement costs remain unchanged.
A51 The cancellation clause contained in the general conditions of this policy is deleted and replaced by:
This insurance has been arranged on an annual contract basis. As a result, if this insurance is cancelled after the 14 day your right to change
your mind cooling-off period, there will not be a refund of premium given and the full annual premium is due.
B14 The 'windscreen damage' sub-section of section 2 of your document (Loss of or damage to your vehicle) is deleted and replaced by the
following. Windscreen damage (comprehensive cover only) You may claim for damage to your vehicle's windscreen or windows and for any
bodywork scratched by broken glass from the window or windscreen. This benefit does not apply to damaged sunroofs, roof panels, lights or
reflectors, whether glass or plastic. You must pay the first 150 of every claim you make under this part of your insurance. We will reduce this
to 90 if you call our 24-hour windscreen helpline on 0844 561 1934 and the repair or replacement is carried out by the authorised windscreen
company that they recommend. Where the cost of repair of the windscreen is less than 150, no excess will apply regardless of whether our
approved repairer is used. If we pay under this part of your insurance, this will not affect your no claim bonus.





Equity Red Star is managed by Equity Syndicate Management Limited which is authorised and regulated by the Financial Services Authority.
Equity Syndicate Management Limited is Registered in England and Wales No. 426475.
Registered Office: Library House, New Road, Brentwood, Essex CM14 4GD.

Client Ref: 373005598 Printed on: 6 November 2012 Page 1 of 7 20110830/1
Equity Red Star
Statement of Motor Insurance


Agents Name Adrian Flux Insurance Services Policy Number/Client Ref 34626810
Address Adrian Flux Insurance Group, East Winch Hall Broker Reference 373005598
East Winch Scheme: Equity Red Star - 6430 Cult Car Scheme EDI
KINGS LYNN Agency Number (If known) 18774
Norfolk
PE32 1HN

IMPORTANT PLEASE READ CAREFULLY
Please read the following information carefully. It is a record of Statements made and information given orally, or in writing on the 05/11/2012 and forms the
basis of your contract of insurance. If you are satisfied that, to the best of your knowledge and belief, this is a true statement of the facts you need take no
further action, simply retain the form in a safe place along with your policy and Certificate of Insurance. If any of the following details appear to be incomplete
or incorrect please contact your broker immediately. Failure to do so could invalidate your insurance. You will be advised of any changes in the premium or
terms and a revised Statement will be issued to you.

On payment by you of the premium requested and subject to the Statement being correct and not being returned to you, you are accepting the insurance
offered on the terms contained in this Statement, the policy document and the Certificate of Motor Insurance.

Your Details Please initial any alterations
Full Name Mr Raymond Law Marital Status Married Contact Numbers
Full Address 20 The Limes
Erdington
BIRMINGHAM
W Midlands
United Kingdom
B24 8AF
Gender Male Home 01213738970
E-Mail Address sue_law@rocketmail.com Mobile 07
Residential
Status
Owned By Proposer - Home
Owner
Home 01213738970
Have you had a County Court Judgement registered against you in the past six years and/or defaulted on any credit agreement? No

Cover
Cover to commence at 14:56:00 on 05/11/2012 For a period of 12 months.
Type of cover Comprehensive Voluntary excess 0
Driving restriction Insured And Spouse No Claims Bonus Protection required (if available) No

Vehicle Details
Make and Precise
Model
FORD CAPRI
Cubic
Capacity
2792
Body
Type
Hatchback
Registration number D760 BFP
Year of first
registration
1987 Is the vehicle Q Plated? No
Purchase price 7150
Estimated annual
mileage
3000
Has the vehicle been
imported?
No
Purchase date 01/06/1988 Current mileage Vehicle owned by Proposer/Policyholder
Estimated Value 2000 ABI code 17509802 Registered keeper Proposer/Policyholder
Are there any security devices fitted and in operation on this vehicle? If Yes provide details below Yes

Has your vehicle been modified, altered or adapted in any way from the manufacturers standard specification, including any manufacturer or dealer fitted options, whether or not
performance is altered, or do you intend to alter it later? If Yes provide details below No

Details of any security or tracking devices fitted to the vehicle Details of any Modifications to the Vehicle
Security Device Installer
Cert
Seen Ind
Modification Type
Modification
Value ()
Unspecified CAT 1 VSIB Accredited Installer No


NB Failure to disclose any modification could result in the policy being declared invalid. If in doubt you should disclose it.
E.g. engine or body modifications, special or non-standard equipment, non-standard or alloy wheels, cosmetic changes, sound systems.

State the address at which
the vehicle is normally kept
20 The Limes
Erdington
BIRMINGHAM,
B24 8AF
Where is the vehicle normally kept at
night
Parked On Drive


Equity Red Star is managed by Equity Syndicate Management Limited which is authorised and regulated by the Financial Services Authority.
Equity Syndicate Management Limited is Registered in England and Wales No. 426475.
Registered Office: Library House, New Road, Brentwood, Essex CM14 4GD.

Client Ref: 373005598 Printed on: 6 November 2012 Page 2 of 7 20110830/1
Give Details Below of All Persons Who Will Drive the Vehicle, Including Yourself (Drivers under 25 years of age must be disclosed)
Full Name Mr Raymond Law Mrs Susan Law
Marital Status & Gender Married Male Married Female
Date of Birth & Age 06/12/1965 age: 46 21/02/1967 age: 45
Type of driving licence held Full UK Car Licence Full UK Car Licence
Period driving licence held (years) 20 20
Date driving test passed 12/09/1992 12/09/1992
Occupation (1
st
occupation) Factory Worker Nurse
Nature of employers business (1
st

occupation)
Motor Manufacture Health Authority

Employment Status (1
st
occupation) Employed Employed
Occupation (2
nd
occupation if
applicable)


Employers business (2
nd
occupation if
applicable)


Employment Status (2
nd
occupation if
applicable)


Relationship of this driver to the
Proposer
Proposer Spouse

Are you the Main User of this vehicle? Yes No
Nature of this drivers use of this
vehicle?
Commuting
Social, Domestic And
Pleasure


Does this driver own another vehicle? Yes Yes
Does this driver have use of another
vehicle?
Yes Yes
Have you been convicted of any non-
motoring offence, including offences
relating to theft, fraud or dishonesty? *
No No
Have you any prosecution or police
enquiry pending? *
No No
Have you been disqualified from
driving? *
No No
Have you been declined or refused
any type of insurance or had any
special term imposed? *
No No
Have you had previous terms applied?
*
No No
Restrictions to licence No Restrictions No Restrictions
* If answered Yes please give full details in additional information







Insurance History
Name of previous insurer Unlisted Insurer Policy number .......
Number of years No Claims Bonus 0 Expiry Date 05/11/2012 14:56:00
Was your previous No Claims Bonus
protected?
No Type of policy Private Car Bonus

THE ONUS IS ON YOU TO ENSURE THAT YOU AND ALL NAMED DRIVERS HOLD A VALID DRIVING LICENCE(S)
AND/OR CBT CERTIFICATE (IF APPLICABLE) FOR THE VEHICLE(S) YOU ARE PROPOSING TO INSURE.
FAILURE TO HOLD A VALID LICENCE WILL MAKE THIS INSURANCE INVALID AND ALL COVER WILL STOP
FROM THE START OF THE CONTRACT.
WE RESERVE THE RIGHT TO REQUEST A COPY OF ANY DRIVERS LICENCE AT ANY TIME.

Equity Red Star is managed by Equity Syndicate Management Limited which is authorised and regulated by the Financial Services Authority.
Equity Syndicate Management Limited is Registered in England and Wales No. 426475.
Registered Office: Library House, New Road, Brentwood, Essex CM14 4GD.

Client Ref: 373005598 Printed on: 6 November 2012 Page 3 of 7 20110830/1
Driving History

Claims
Have you or any person who may drive been involved in any accident, claim or loss (including loss by fire, theft or malicious acts), irrespective of blame,
during the past three years? Yes If Yes please provide full details below.
Driver Name Date Claim Type Claim Status NCD
Affected
At
fault?
Costs ()
Mr Raymond Law 01/09/2008 Accident Settled Yes Yes 1000
Mrs Susan Law



*or would have had if not been for the operation of No Claims Discount Protection
Convictions
Have you or any person who may drive been convicted of any motoring offences, including fixed penalty offences, within the last five years? No
If Yes please provide full details below.
Driver Name Date Motoring Offence Code Alcohol Reading
(if any)
Fine () Penalty Points Disqualification
Period (Months)
Mr Raymond Law
Mrs Susan Law




Medical
Does any driver suffer from a notifiable medical condition not notified to DVLA or any condition for which DVLA have restricted the licence? No
If Yes please provide full details below.
Driver Name Nature of Condition Date of onset DVLA Advised?
Mr Raymond Law


Mrs Susan Law












Qualifications
Has any driver passed a Motoring Qualification? No If Yes please provide full details below.
Driver Name Qualification Description Date Obtained
Mr Raymond Law



Mrs Susan Law
















ADDITIONAL INFORMATION





Equity Red Star is managed by Equity Syndicate Management Limited which is authorised and regulated by the Financial Services Authority.
Equity Syndicate Management Limited is Registered in England and Wales No. 426475.
Registered Office: Library House, New Road, Brentwood, Essex CM14 4GD.

Client Ref: 373005598 Printed on: 6 November 2012 Page 4 of 7 20110830/1
IMPORTANT NOTES

Insurers pass information to the Claims and Underwriting Exchange Register, run by Insurance Database Services Ltd (IDS Ltd), the Hunter Database, run by Experian, and
the Motor Insurance Anti-Fraud and Theft Register, run by the Association of British Insurers (ABI). The aim is to help us to check information provided and also to prevent
fraudulent claims. We may search these registers when we deal with your request for insurance. Under the conditions of your policy, you must tell us about any incident
(such as an accident or theft) which may or may not give rise to a claim. When you tell us about an incident we will pass information relating to it to the registers. Your
policy details will be added to the Motor Insurance Database (MID), run by the Motor Insurers Bureau (MIB). MID and the data stored on it may be used by the DVLA,
DVANI, the Insurance Fraud Bureau and other bodies authorised by law for the purposes of but not limited to Electronic Vehicle Licensing, Continuous Insurance
Enforcement, law enforcement for the purposes of prevention, detection, apprehension, and or prosecution of offenders and by 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 (in the UK, EEA or certain other territories), other insurers
and/or the Motor Insurers Bureau may search the MID to obtain relevant policy information. Persons pursuing a claim (including his or her appointed representatives) 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
current 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 www.askmid.com. You should show this notice to anyone insured to drive the vehicle covered under the policy.
Warning: If you are in any doubt about a particular fact(s) being material to this insurance you should declare it/them. Failure to disclose all material information
may result in this insurance being void from inception leaving you without insurance cover. You should keep a complete record (including copies of letters) of all
information supplied to Underwriters for the purpose of entering into this Contract of Insurance.
Underwriters liability does not operate until acceptance has been notified and Cover Note or Certificate of Motor Insurance delivered to the insured. If the proposal should
disclose any special features, the Underwriters may quote special terms and they reserve the right to decline a proposal.
Details of full policy terms will be supplied on request.
You and Equity Red Star are free to choose the law applicable to this insurance contract. Unless we have agreed otherwise with you, this insurance is governed by English
law.
At your request, a copy of this completed form will be supplied to you, provided the request is made within a period of three months after its completion.

COMPLAINTS PROCEDURE
We aim to provide a first-class service. If you have any cause to complain, or you feel that we have not kept our promise, please contact your insurance advisor. If you are
not happy with the way the matter is dealt with, please write to: The Chief Executive, Equity Red Star, Library House, New Road, Brentwood, Essex, CM14 4GD, quoting
details of your insurance, including the insurance document number, which is on you certificate of motor in insurance and your policy schedule. After this action, if you are
still not satisfied with the way a complaint has been dealt with, you may ask the Policyholder & Market Assistance department at Lloyds to review your case. (This would
not affect your rights to take legal action if necessary). The address is: Policyholder & Market Assistance, Lloyds Market Services One Lime Street, London, EC3M 7HA.

Having followed this procedure your complaint can be referred to the Financial Ombudsman Service (FOS). The address is The Financial Ombudsman Service, South Quay
Plaza, 183 Marsh Wall, London E14 9SR (These procedures do not affect your right to take legal action if necessary). Lloyds is a member of the Financial Ombudsman
Service.

DATA PROTECTION ACT
The details you have provided will be used by Equity Red Star Services Limited to process your request in accordance with the Data Protection Act 1998 and other applicable
laws. We share data with approved organisations for underwriting and fraud prevention purposes. Your data may also be processed outside the European Economic Area. In
all instances we take steps to ensure an adequate level of protection is given to your information. In order to assess the terms of an insurance contract or administer claims
that arise, we may need to collect data that the Data Protection Act 1998 defines as sensitive (such as medical data or criminal convictions). In order to process your
information for the purposes of providing insurance and claims handling, it may be necessary to pass your information to carefully selected third parties and other Group
companies. By proceeding with this application you signify your consent to such information being processed in this way.

If you have any queries, please contact the Company Secretariat at: Equity Insurance Group Limited, Library House, New Road, Brentwood, Essex CM14 4GD.

DECLARATION
I/we understand that you will pass the information on this form, and about any incident I/we may give details of to IDS Ltd, Experian and ABI so that they can make it
available to other insurers. I/we also understand that, in response to any searches you may make in connection with this application or any incident I/we have given details of,
IDS Ltd, Experian and ABI may pass you information they have received from other insurers about other incidents anyone insured to drive the vehicle covered under the
policy have been involved in. I/we declare that the answers given (on which the Underwriters will rely when deciding whether to accept the risk and in fixing the premium)
are true to the best of my/our knowledge and belief and that the vehicle(s) described is/are in roadworthy condition and that no information has been withheld by me/us that
might influence the Underwriters acceptance and assessment of this insurance, and to accept a policy subject to its terms, conditions and exceptions. I/we also agree that if
another person has given any information on this form, he or she acted as my/our agent for this purpose. I/we hereby consent to any information you may have about me/us
being processed by you for the purpose of providing insurance and claims handling, which may necessitate your providing such information to third parties.

Please read all notes above and on supplementary pages.















Equity Red Star is managed by Equity Syndicate Management Limited which is authorised and regulated by the Financial Services Authority.
Equity Syndicate Management Limited is Registered in England and Wales No. 426475.
Registered Office: Library House, New Road, Brentwood, Essex CM14 4GD.

Client Ref: 373005598 Printed on: 6 November 2012 Page 5 of 7 20110830/1




ABOUT THIS DOCUMENT
Please note that this policy summary does not contain the full terms and conditions of the contract of insurance, which can be
found in the insurance document.

INSURER
Equity Red Star is managed by Equity Syndicate Management Ltd which is authorised and regulated by the Financial Services Authority. Our registration
number is 204851.

TYPE OF INSURANCE AND COVER
Equity Red Star offers the following Private Car Motor insurance covers.
* Third Party Only (TPO)
* Third Party, Fire & Theft (TPFT)
* Comprehensive (COMP)

COVER SPECIFIC FEATURES AND BENEFITS (referenced to the numbered sections contained in the insurance
document)
Third Party Only - TPO
Section 1 - Liability to others
Section 8 - Foreign use

Third Party, Fire and Theft - TPFT
Section 1 - Liability to others
Section 2 - Loss of or damage to your vehicle (not including accidental or malicious damage and vandalism or windscreen
cover)
Section 8 - Foreign use

Comprehensive - COMP
Section 1 - Liability to others
Section 2 - Loss of or damage to your vehicle
Windscreen cover
New car replacement
Section 3 - Medical expenses
Section 4 - Personal accident benefits
Section 5 - Personal belongings
Section 6 - Garage
Section 7 - Loss of vehicle excise licence
Section 8 - Foreign use

SIGNIFICANT OR UNUSUAL EXCLUSIONS OR LIMITATIONS (BY SECTION)
SECTION 1
The most we will pay for property damage is 20,000,000 for any one claim or claims arising out of one incident. The most we
will pay for costs and expenses arising from property damage is 5,000,000 for any one claim or claims arising out of one
incident.

SECTION 2
You must pay an amount towards any claim that you may make under Section 2 of the insurance. This amount is called the
excess. More than one excess may apply to a claim, but details of all excesses, including windscreen, will be shown in
Section 2 of the insurance or in the policy schedule. Where our recommended repairer is used, the excess payable towards
an authorised windscreen claim will be 90.

There is a 400 limit on cover for permanently fitted audio or telephone equipment which is not the manufacturer's standard
fitted equipment (less any excess you must pay).
New car replacement applies to vehicles less than one year old that are damaged so that repairs will cost more than 50% of
the manufacturers Recommended Retail Price.
If your vehicle is damaged while a young or inexperienced person (including you) is driving you will have to pay the following
excesses (on top of the other amount that you must pay).


Equity Red Star is managed by Equity Syndicate Management Limited which is authorised and regulated by the Financial Services Authority.
Equity Syndicate Management Limited is Registered in England and Wales No. 426475.
Registered Office: Library House, New Road, Brentwood, Essex CM14 4GD.

Client Ref: 373005598 Printed on: 6 November 2012 Page 6 of 7 20110830/1
Drivers Amount
Under 21 years of age. 300
Aged 21 to 24 years of age. 200
25 or over but who have not held, for 12 months or more, a full EU driving licence. 200

Loss of or damage to your vehicle or its contents by theft or attempted theft or an unauthorised person taking and driving it will
not be covered if it has been left unlocked, left with the keys in it, left with the windows, roof panel or the roof open (in the case
of a convertible vehicle) or reasonable precautions have not been taken to protect it.

SECTION 3
There is a 500 limit (per person) on Medical expenses.

SECTION 4
Personal Accident benefits are only given to the policyholder and their husband, wife or civil partner (while under 70 years of
age), and are restricted to accidents resulting from travelling in, or getting into or out of, private motor vehicles. The limits to
the amounts that we will pay are as follows.

Type of injury Amount we will pay
Death 3,500
Loss of any limb 1,500
Permanent blindness in one or both eyes 1,500
The most we will pay is 3,500 in any one period of insurance.

SECTION 5
Personal belongings cover applies up to a limit of 100 and will not apply to money, goods or samples connected with your
work, property insured under any other contract or property that was not reasonably protected.

SECTION 8
Foreign use is limited to trips of up to 60 days and will only apply where your permanent home is in Great Britain, Northern
Ireland, the Channel Islands or the Isle of Man.

PERIOD OF INSURANCE
The insurance offered is a 12-month contract, which may be renewed each year. Renewal will be subject to the terms and
conditions that apply at the time of renewal.

CANCELLATION
You may cancel the insurance at any time by sending us written notice and returning the certificate of insurance. The charges
that will apply are detailed in the General conditions section of the insurance document.
Your right to change your mind
As long as your vehicle has not been written off as a result of a claim under the insurance, you may cancel the insurance,
without giving reason, by sending us written notice and returning the certificate of insurance within 14 days of it starting or (if
later) within 14 days of you receiving the insurance documents. We will make a charge equal to the period of cover you have
had, but this charge will be subject to a minimum amount of 25 + Insurance Premium Tax (IPT).

HOW TO CLAIM
If a claim or possible claim occurs you must report it to us as soon as possible. Please phone our 24-hour helpline on 0844
800 1937 or if the claim is solely for windscreen damage please call 0844 561 1934.

COMPLAINTS
If you have any cause to complain about your insurance, or us, please contact the intermediary who administers your
insurance on our behalf.

If your intermediary cannot resolve your complaint, you should write to the Chief Executive of Equity Red Star at Library
House, New Road, Brentwood, Essex, CM14 4GD. When you do this, quote your insurance document number as it will help
us to deal with your complaint promptly.

After this action, if you are not satisfied with the way your complaint has been handled, you may ask the Policyholder &
Market Assistance department at Lloyds to review your case. The address is Policyholder & Market Assistance, Lloyds
Market Services, One Lime Street, London EC3M 7HA.


Equity Red Star is managed by Equity Syndicate Management Limited which is authorised and regulated by the Financial Services Authority.
Equity Syndicate Management Limited is Registered in England and Wales No. 426475.
Registered Office: Library House, New Road, Brentwood, Essex CM14 4GD.

Client Ref: 373005598 Printed on: 6 November 2012 Page 7 of 7 20110830/1
If you remain dissatisfied after contacting Lloyds, you can then refer your case to the Financial Ombudsman Service (FOS).
The address is The Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London E14 9SR.

This procedure does not affect your right to take legal action if necessary.

FINANCIAL SERVICES COMPENSATION SCHEME (FSCS)
If Equity Red Star is unable to meet its liabilities under this insurance, you may be entitled to compensation from the FSCS. A claim is
protected for 90% without any upper limit. For compulsory types of insurance the claim will be met in full. You can get further
information about the compensation scheme arrangements from the FSCS. Information can be obtained on request, or by visiting the FSCS
website at www.fscs.org.uk.

LANGUAGE AND LAW APPLYING TO THE INSURANCE
This insurance is written in English and all communications about it will be in English. Unless we have agreed otherwise with
you, English law will apply to this insurance.

PSPCSS 10/11




SUPPLEMENTARY INFORMATION FORM

Please Complete, sign and return this form


Client Name Mr Raymond Law
Client Address 20 The Limes Erdington BIRMINGHAM W Midlands
Client Postcode B24 8AF

Insurer Policy Number 34626810 issued 05/11/2012
Client Policy Number 373005598 - Sterling Insurance Services


We have the following contact details for you and we would be grateful if you could check these carefully and
advise of any missing information or errors.

Mobile Telephone Number 07
Home Telephone Number 01213738970
E-Mail Address sue_law@rocketmail.com




Any Other Motor Vehicles In The Family (Including Motorcycles & Motorhomes)
Please do not include vehicles already insured with ourselves

Make (eg Ford) Model (eg Focus) Specification (eg Zetec) Renewal Date (dd/mm/yy)



Please provide the make and model of all other motor vehicles in the household along with estimated renewal date of current policy

Home Renewal Date
(dd/m/yy)
Contents Insurance
Buildings Insurance
Please provide estimated renewal date of current policy

We will contact you prior to the renewal date of these policies.

Please advise if you would prefer to be contacted by E-mail In Writing By Telephone




Proposers Signature

X

Date
X




Ref: 373005598/16
Name: Mr Raymond Law (Adrian Flux Insurance)

LIMITED MILEAGE AGREEMENT/DECLARATION


I hereby certify that the mileage reading of my vehicle, registration number D760 BFP on 05/11/2012 was






miles/kilometres (delete as appropriate),
(1 mile = 1.609 kilometres)


and I also certify that this vehicle will not exceed 3000 miles before 04/11/2013.

I understand that should I wish to exceed this stated mileage, I will inform my brokers in advance of doing so and agree to
pay the additional premium required by the insurance underwriters.

I also understand that failure to comply with this requirement may prejudice any cover granted. (Refer to policy for full
wording and terms)

NB: Normal suspension benefits are not applicable to limited mileage policies.

Please note that any change of vehicle amendment during the term of insurance will require the completion of a
declaration. The declaration must confirm the closing mileage reading on the removed vehicle and the opening
mileage reading for the replacement vehicle. Failure to provide the closing mileage may result in an amendment
to the terms of your policy.


Proposers Signature

X

Date

05/11/2012




Ref: 373005598/16
Name: Mr Raymond Law (Adrian Flux Insurance)


AGREED VALUE REQUEST FORM HELPSHEET

What happens if I don't want to have an Agreed Value?

Agreed Value is optional and so if we do not receive the required documentation or payment then the policy will still continue, however
it will be on a 'Market Value' basis.

What should my seven photographs actually show?

They must be recent colour photographs. Your photographs must show each of the following Each side of the vehicle (i.e. one
photograph of the driver's side and one of the passenger's side), one photograph of the front of the vehicle, one of the back, one of the
engine bay, one of the mileometer and one of the interior. Please ensure that the vehicle is clean, inside and out before taking the
photographs. The photographs should be clear and crisp, with no 'soft-focus' or blurring. There should be no obstructions such as
posts, bushes, trees or walls.

Vehicle Sides (2 photos).
These photographs should be taken whilst you are at the side of the vehicle (i.e. 'three-quarter' shots will not suffice). They should
show the full length and height of the vehicle. There should be sufficient light to show all details of the side profile.

Vehicle Front (1 photo).
This photograph should be taken whilst you are directly in front of the vehicle (i.e. 'three-quarter' shots will not suffice). They should
show the full width and height of the vehicle. There should be sufficient light to show all details of the front, and the registration number
(if fitted) should be clearly visible.

Vehicle Rear (1 photo).
This photograph should be taken whilst you are directly behind the vehicle (i.e. 'three-quarter' shots will not suffice). They should show
the full width and height of the vehicle. There should be sufficient light to show all details of the back, and the registrat ion number
should be clearly visible.

Engine Bay (1 photo).
This should show the entire engine bay.

Mileometer (1 photo).
This should show the mileage reading of the mileometer (odometer) for the vehicle. If it is a vintage vehicle that has no mileometer,
then please enclose a signed letter declaring that this is the case.

Interior (1 photo).
For most vehicles the interior shot should show the state and condition of the key elements within the vehicle. For campervans and
motorhomes, therefore, we request that the interior shot is taken towards the rear of the vehicle to show the living accommodation. For
other vehicles it is best to show the interior at the front of the car. It is a good idea to shoot through an open passenger door and try to
include the front seats and steering wheel/dashboard in the picture. Again, make sure the picture is sharp, not blurred. There should be
sufficient light to show all details of the interior.

Do I need to fill in all of the fields on the Agreed Value form?

Yes. If, for example, there has been no restoration or repair work done since purchase then you simply put 'N/A' in that field. At least by
filling in 'N/A' rather than leaving it blank we know that the form is fully completed and you haven't simply overlooked a question. If the
form isn't fully completed it will be returned to you, which will delay the agreed value process.

There are some features on the vehicle that I am unsure as to whether they are standard
equipment or a modification. Should I declare these?

Yes. Please always declare any facts that you feel may be classed as material facts, including vehicle modifications and
repairs/restoration. It is always better to disclose more information than we need, rather than not enough!


What do I need to send back to you in the Agreed Value envelope?
The seven photographs outlined above (driver side, passenger side, front, rear, engine, mileage, interior)
The signed, completed Agreed Value form.

The Payment details (either include cheque/postal orders made payable to Adrian Flux Insurance, or tick the
credit/debit card option on the agreed value form)
NB Please make sure that the form and photographs are all sent to us at the same time to avoid delays





Ref: 373005598/16
Name: Mr Raymond Law (Adrian Flux Insurance)

AGREED VALUE REQUEST FORM

Adding the optional Agreed Value on your policy is very simple, just fill in the form below and then send it back to us with the relevant
photographs of the vehicle and the required payment. Please bear in mind that, because adding Agreed Value to your policy is
optional, until we receive everything and confirm that we have agreed the value, your policy will continue to run on a Market Value
basis. Please remember to fill in all of the fields below, and anything that is not relevant please state N/A.

Vehicle Make: Vehicle Model: Registration Number: Year of Make:
FORD CAPRI D760 BFP 1987

Vehicle CC (or HP): Gearbox: Overnight Parking: Date of Purchase:
2792 Manual Parked On Drive 01/06/1988

Please confirm the following details marked *

Vehicle Condition (tick either Excellent,
Good, Average or Poor for each )
* Bodywork
* Electrical
equipment
* Chassis/
Floor pan
* Interior * Tyres
* Engine &
transmission
Excellent
Good
Average
Poor

Left Hand Drive: * Purchase Price: * Requested Value: * Current Mileage Reading:
Yes / No

* Restoration repairs and details of work carried out since purchase (if any), please also give dates and costs. Please use and attach
additional sheets if necessary:




* Modification details (if any) carried out since purchase (only if different to standard Manufacturer's Specification), please also give
dates and costs. Please use and attach additional sheets if necessary:




Important: You are reminded that you must disclose any facts which an insurer would regard as likely to influence the acceptance and assessment of
this risk: failure to disclose all material facts may invalidate the insurance contract. If you're in doubt about facts considered as material, you must
disclose such facts on this form.
Declaration and Signature: I declare that to the best of my knowledge and belief, the information given above is true and complete in every detail
and that no information which may influence acceptance of this risk has been withheld. I am aware that the underwriters retai n the right to request an
independent valuation if they feel the photographs do not reflect the true value of the vehicle insured.

* DATE:
X
* POLICYHOLDER SIGNATURE:
X

Please note that a Payment of 15.00 is also required. You can either pay for this via a credit/debit card that you have previously
used, or you can include a cheque or postal orders made payable to Adrian Flux Insurance with this form. Please state your method of
Payment below.
Please tick

I have enclosed a cheque and/or postal orders made payable to Adrian Flux Insurance, totalling 15.00

I give you authority to use my credit/debit card ending ************6657, expires 08/2015 for my 15.00 payment

Finally, an integral part of the Agreed Value process is to send us some recent colour photographs of your vehicle.
Regrettably photographs sent to us cannot be returned, but we are happy to receive digital photographs, either on a CD or
printed onto photographic paper. Please send these photographs to us along with this signed and completed form (and any
cheques/postal orders) using the pre-paid envelope provided. We are keen to avoid delays in issuing your agreed value, so to
help you know precisely what we need the photographs to show, and what you must include when sending this form, please
see the enclosed helpsheet.





FLUX RESCUE Vehicle Breakdown Service
Service provided by Equity Red Star



SCHEDULE
This insurance only covers the vehicle specified on this schedule.

If your vehicle breaks down call our Rescue Control Centre 24 hours a day 365 days a year.
From the UK : 0800 328 8349
From Europe : 00 800 999 00 999



Document Number FLU/373005598
Services Applicable UK and European
Period of Insurance 05/11/2012 to 04/11/2013
Insured Mr Raymond Law
Address 20 The Limes, Erdington, BIRMINGHAM, W Midlands. B24 8AF
Insured Vehicle FORD CAPRIINJECTION SPECIAL

Registration Number D760 BFP

Date First Registered 1987

Premium Payable 36

Date of Issue 05/11/2012


For and on behalf of Flux Rescue
This insurance becomes valid upon signing and the issue of the Insurance Document



Language and law applicable to contract:
This insurance is written in English and all communications about it will be in English. Unless we have agreed otherwise
with you, in writing, this insurance is subject to English Law.



Preamble
This Document is a legally binding contract of insurance between YOU (the Insured) and US (Equity Red Star). The
contract is based on the information you provided in your signed proposal form or statement of insurance. We have
agreed to insure you under the terms, conditions and exceptions contained in this booklet or in any endorsement
applying to this booklet. The insurance provided by this document covers any liability, loss or damage that occurs during
any period of insurance for which you have paid, or agreed to pay the premium.


Signed for and on behalf of
EQUITY RED STAR

(UNDERWRITER)