Policy Number: FPM6010974102FC

Start Date: 29/03/2021 19:11

Statement of Fact
Please read the following information carefully. It is a record of statements made and information given by you and constitutes the basis of your
contract of Insurance. If any information is omitted or is incorrect, please telephone us immediately with the correct information and we will send you
a revised Statement of Fact. If any of the information is incorrect it could invalidate your Insurance or result in a claim not being paid.

1. Proposer Details
Name Mr Sarfraz Zahoor
Postcode B62 8NP
Full Address 8 Coombs Farm Mews, HALESOWEN, West Midlands
Telephone Mobile
07506915697 Telephone Work 07506915697 07506915697
Home Number
Correspondence
Email sarfrazzahoor90@gmail.com 8 Coombs Farm Mews, HALESOWEN, West Midlands, B62 8NP
Address

2. All Drivers
Policyholder Named Driver Named Driver Named Driver
Surname Zahoor
Forename Sarfraz
Date of Birth 24/01/1990
Marital Status Separated
Lived in UK Since 24/01/1990
Employment status Employed
Occupation Shop Assistant
Business Fast Food
Part Time Employment Status
Part Time Occupation
Part Time Business
Licence Type Full (UK)
Date Passed Test 29/03/2012
Additional Driving Qualifications No Qualification
Relationship to Proposer N/A
Frequency of Use Main
Commuting Use Required Yes

3. Vehicle Details
Make & Model VAUXHALL CORSA CLUB Vehicle Imported No
Fuel Type Petrol Registered Owner Policy Holder
No of Seats 5 Registered Keeper Policy Holder
Right Hand Drive Yes Security Fitted Yes
Value £780 Device (Fitted by) Unknown Alarm (Unknown)
Year of Make 2007 Modifications No
Vehicle Registration Number VU57ROH Modification Details N/A
Date Purchased 01/04/2018 Q Plate No
Day Location N/A
Location (Proposer’s Address?) Yes
Overnight Location On Drive
Alternative Location N/A

4. Cover
Comprehensive
Level of Cover Social Domestic & Pleasure (incl
Start Date 29/03/2021 19:11 Expiry Date 28/03/2022 23:59
and Class commuting to a single place of work or
study)
Voluntary No Claims Protected
£250 0 No
Excess Discount (Years) Discount
Total Miles per Business Miles Pleasure Miles
3000 0 3000
Year per Year per Year
Has any driver had any criminal convictions, cautions or pending prosecutions? No
Have you or any person who may drive ever had any type of insurance refused, declined or cancelled? No

Page 1 of 2
 Policy Number: FPM6010974102FC
Start Date: 29/03/2021 19:11

5. Accidents - Has any driver had any accidents, claims, thefts, incidents or losses regardless of fault or blame in the last five years? Yes, details are below:
Name Date of Claim Description Fault NCB
Mr Sarfraz Zahoor 21/09/2020 Accident Yes Yes
Mr Sarfraz Zahoor 15/11/2020 Accident Yes Yes
Mr Sarfraz Zahoor 05/12/2016 Accident Yes Yes

6. Convictions - Has any driver had any motoring convictions, fixed penalty offences or driving disqualifications in the last five years? No
Penalty Disqualification Level & Type of Reading
Name Conviction Date Offence Code Fine
Points Period (months) (for Drink Driving)

Important Information:
It is an offence to make a false statement or to withhold information, to obtain a Certificate of Motor Insurance.
You should tell us immediately of any alteration to the details you have declared on this Statement of Fact. Failure to provide the relevant details in respect of all questions
may result in your policy being made void with no refund of premium allowed and any claim being declined. If you are in any doubt as to whether certain facts are relevant
or not, please ask us. The information you have given may be used to tell you about other products and services provided or recommended by us.

Claims History:
Insurers pass information to the Claims and Underwriting Exchange Register run by Insurance Database Services Ltd (IDS Ltd) 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. When we deal
with your request for insurance, we may search these registers. 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. Failure to provide full details of your
claims/conviction/fixed penalty notice history may result in your policy being made void with no refund of premium allowed and any claim being declined. If you have any
doubt over whether an item should be disclosed please contact our sales team.

Motor Insurance Database:

Information relating to your insurance policy will be added to the Motor Insurance Database (MID) managed by the Motor Insurers’ Bureau (MIB). MID and the data stored
on it may be used by certain statutory and/or authorised bodies including the Police, the DVLA, the DVANI, the Insurance Fraud Bureau and other bodies permitted by law
for purposes not limited to but including
Electronic Licensing
Continuous Insurance Enforcement;
Law enforcement (prevention, detection, apprehension and or prosecution of offenders)
The provision of government services and or other services aimed at reducing the level and incidence of uninsured driving.

If you are involved in a road traffic accident (either in the UK, the EEA or certain other territories), insurers and or the MIB may search the MID to obtain relevant
information. Persons (including 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 check that your correct registration number details are shown on the MID at www.askmid.com.

Contract, Law and Credit Reference Agencies:

This contract is between you (the policyholder named on the previous page of this document) and the insurer shown on your Certificate of Motor Insurance. We (First
Central Insurance Management) are authorised to act on the insurer’s behalf. English law will apply to this contract unless we and you have agreed otherwise.
When we provided you with a quote and assessed the payment options most appropriate for you, we made checks on the electoral roll and other data through a credit
reference agency. A record of the check will be held by the credit reference agency who may place a search footprint on your credit file that may be seen by other lenders.
We may continue to obtain information through credit reference agencies to check your credit status and suitability for other products we may offer.

Fraud Prevention, Detection & Claims History:

In order to prevent and detect fraud we may at any time; Share information about you with the police, 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 of services to you, trace debtors or beneficiaries, recover debt, prevent fraud and to manage your accounts or insurance policies. We will also check your
identity to prevent money laundering, unless you furnish us with satisfactory proof of identity. W e may also undertake credit searches and liaise with additional fraud
services. We can supply on request further details of the databases we will access or contribute to.

ST
1 CENTRAL is a trading name used by First Central Insurance Management Ltd which is authorised and regulated by the Financial Conduct Authority (firm reference number: 483296).
Registered in England and Wales (number: 6489797) at Capital House, 1 – 5 Perrymount Road, Haywards Heath, West Sussex. RH16 3SY.

20210501/PD/3.1/v1.5

Page 2 of 2