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Statement of Facts
Agency Name Address My Motor Quote Garrick House 161 High Street Hampton Hill Middx TW12 1NG Date Issued 1st December 2011

Agency Number 00011

The following details directly affect your insurance. Please check them carefully and inform My Motor Quote if any of the information is incorrect or has changed.

POLICYHOLDER

Name Address

Mr Zain Nasir 26 Endbutt Lane Liverpool L23 0TR

Home Telephone Number Work Telephone Number Marital Status Client Reference Policy Number Single

07405899582

NAZX08PC01 231/00011/002067

VEHICLE DETAILS
Description VOLVO S40 CD AUTO Modifications: None Security: Immobiliser: Unknown Thatcham 1 L23 0TR Alarm: Unspecified Normally kept overnight: Registered Keeper: Garaged Proposer Estimated Annual Mileage: 2000 Registration R977 VUD Year 1997 Value 1000 Engine Size 1948 Right Hand Drive Yes Fuel Petrol

Postcode where vehicle kept: Owned By: Main Driver: Proposer Mr Zain Nasir None

Previous Insurer:

No Claim Discount: 19 years

No Claim Discount Protection:

No

POLICY COVER

Period: Policy Cover: Voluntary Excess:

1st December 2011 15:42 to 30th November 2012 23:59 Comprehensive 500

PERMITTED DRIVERS
Your Certificate of Motor Insurance shows the permitted use(s) and any restrictions. Name Occupation Date of Birth 01/08/1962 Licence Type Full Years Licence Held 30 years UK Resident 48 years Relationship to Proposer N/A

Mr Zain Nasir

Retired

MATERIAL DISCLOSURE Failure to disclose all material information or any change in the information could invalidate your insurance. If you are in any doubt if any of the information is material it should be disclosed. It is an offence under the Road Traffic Act to make any false statements or withhold any information to obtain a Certificate of Motor Insurance. ABC insurance is a registered trade mark and is a trading style of the Liverpool Victoria group of companies. Liverpool Victoria Insurance Company Limited (LVIC), registered in England and Wales number 3232514, is authorised and regulated by the Financial Services Authority, register number 202965. Registered address for both companies: County Gates, Bournemouth BH1 2NF. Tel: 01202 292333 Page 1 of 4

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Agent: My Motor Quote Agency No: 00011 NAZX08PC01 Client:

ADDITIONAL DETAILS CONVICTIONS

Conv. no Driver None Details below of any motoring offences in the last 5 years including any fixed penalty offences, any prosecutions or police enquiries pending. Code Conviction date Period suspended Points Fine

ACCIDENTS
Acc. no Driver None

Details below of any motoring accidents, claims or losses in the last 5 years, irrespective of blame and whether or not a claim was made. Type Date At fault Own loss T.P. loss Personal injury

ABC insurance is a registered trade mark and is a trading style of the Liverpool Victoria group of companies. Liverpool Victoria Insurance Company Limited (LVIC), registered in England and Wales number 3232514, is authorised and regulated by the Financial Services Authority, register number 202965. Registered address for both companies: County Gates, Bournemouth BH1 2NF. Tel: 01202 292333 Page 2 of 4

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Agent: Agency No: Client: My Motor Quote 00011 NAZX08PC01

ADDITIONAL DETAILS DISABILITIES

Disabilities
Diabetes Date since Date stable History of attacks ? Controlled by? Sight loss Percentage right eye Percentage left eye Disease related ? Date since ? Hearing loss Percentage right ear Percentage left ear Disease related ? Date since ? Leg loss Disease related ? Date since ? Arm loss Disease related ? Date since ? Infirmity 1 Date since Date stable Infirmity 2 Date since Date stable Infirmity 3 Date since Date stable Renewal period Automatics only ? Wheel knob ? Hand controls ?

Proposer
No disabilities identified

Additional Driver 1

Additional Driver 2

Additional Driver 3

Additional Driver 4

ABC insurance is a registered trade mark and is a trading style of the Liverpool Victoria group of companies. Liverpool Victoria Insurance Company Limited (LVIC), registered in England and Wales number 3232514, is authorised and regulated by the Financial Services Authority, register number 202965. Registered address for both companies: County Gates, Bournemouth BH1 2NF. Tel: 01202 292333 Page 3 of 4

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Important Information
Please take a few minutes to read this document carefully as it contains important information relating to the details that you have given to us. You should show this notice to any other party related to this insurance. Data Protection Act 1998 ('The Act') and Insurance Administration This information is provided to you to explain how we may use your details and to tell you about the systems we have in place that allow us to detect and prevent fraudulent applications and claims. The savings that we make help us to keep premiums and products competitive. For the purposes of The Act the Data Controller of any personal data provided to us in connection with your insurance is Liverpool Victoria Insurance Company Limited. Information provided to us may be held, whether or not a product is purchased, on computer, paper file or other medium to enable us to record the enquiry, for as long as the application is being considered, for as long as the policy remains in force and afterwards to ensure that a clear and complete audit trail of policy records and transaction history is maintained. The information (some of which may be sensitive for example relating to any convictions or your health) may be used to process and administer your business by us and our agents (e.g. service providers both within and outside the European Economic Area with which we have agreements). Also it may be used and/or disclosed to regulators for the purposes of monitoring and/or enforcing our compliance with any regulatory rules, guidance or codes. Occasionally your data may be disclosed to selected third parties who are assisting us in service improvement activities. In the event that you move to a new insurance provider we may confirm certain details relating to your insurance to the new insurer if requested to do so and where are we satisfied that it is a genuine request. In the event of a request to us for policy information by an individual other than the policy owner we will check with the individual that the policy owner has given permission to the individual to communicate with us on the policy owner's behalf. Motor Insurance Database Your policy details 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 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 uninsured driving.

If you are involved in a road traffic accident (either in the UK or abroad), insurers and/or the MIB may search the MID to obtain relevant information. Other persons (including their appointed representatives) pursuing a claim in respect of a road traffic accident (including people who live in 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 not you risk 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 Fraud Prevention and Detection In order to prevent and detect fraud we may at any time: - Share information about you with other organisations and public bodies including the Police; - Check and/or file your details with fraud prevention agencies and databases, and if you give us false or inaccurate information and we suspect fraud, we will record this. We and other organisations may also search these agencies and databases to: - Help make decisions about the provision and administration of insurance, credit and related services for you and members of your household; - Trace debtors or beneficiaries, recover debt, prevent fraud and to manage your accounts or insurance policies; - Check your identity to prevent money laundering, unless you furnish us with other satisfactory proof of identity; - Undertake credit searches and additional fraud searches. Insurance History Under the conditions of your policy you must tell us about any insurance related incidents whether or not they give rise to a claim. When you tell us about an incident we will pass information relating to it to a database. We may search these databases when you apply for insurance, in the event of any incident or claim, or at time of renewal to validate your claims history or that of any other person or property likely to be involved in the policy or claim.
ABC insurance is a registered trade mark and is a trading style of the Liverpool Victoria group of companies. Liverpool Victoria Insurance Company Limited (LVIC), registered in England and Wales number 3232514, is authorised and regulated by the Financial Services Authority, register number 202965. Registered address for both companies: County Gates, Bournemouth BH1 2NF. Tel: 01202 292333 Page 4 of 4