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Equipment Insurance Application Form (including summary of cover)

Date: 21/08/2018

APPLICATION FORM
SUMMARY OF COVER

PROPERTY INSURED: Healthcare Equipment
INSURER: Aviva
COVER: Business All Risks Maximum Sum Insured: £5,000
GEOGRAPHICAL LIMITS: Anywhere in the World up to a maximum of 90 days in any 12 month period

PREMIUM: £150.00 (inclusive of Insurance Premium Tax & Policy Fees)

SPECIAL CONDITIONS:
(a) The first £100 of any claim is excluded.
(b) In respect of theft from unattended vehicles no cover applies:
(i) unless the vehicle is securely locked (or otherwise kept in a securely locked building)
(ii) between midnight and 0600hrs unless the vehicle is both locked and kept in a securely locked building.
(c) When transported by sea or air, the equipment must be carried as hand luggage and accompany the policyholder.
(d) Cover excludes mechanical and electrical breakdown, failure of parts, mobile telephones or other unrelated equipment
(e) Policyholders have a duty at all times to take reasonable precautions to safeguard the property insured and to disclose facts which may materially affect acceptance of the cover
(f) The Date Recognition General Exception
(g) No cover applies where the policyholder lends or hires out to others the equipment insured
(h) When not in use the equipment must be kept in a securely locked fast building

This summary is not intended to be exhaustive and does not in any way alter the terms of the policy.

A full copy of the policy wording, terms and conditions are available online from our website www.graybrook.co.uk/equipment. Applicants who do not have internet access may apply for a copy to be sent by post prior to purchase.
Disclosure of Material Facts Declaration

Please acknowledge acceptance of the following:
Important Information

Personal Data
The insurer for policies underwriting this scheme is Aviva Insurance Limited. The scheme is administered on their behalf by Graybrook Insurance Brokers Limited.

To arrange and administer your policy Aviva Insurance Limited and Graybrook Insurance Brokers Limited will hold and use information supplied by you, in accordance with U.K. Data Protection Laws and General Data Protection Regulation (GDPR). Full information and your rights about the personal data we collect and process can be found in our Privacy Notice which is available on request and online at www.graybrook.co.uk. A copy of the Privacy Notice will also be included in your quotation/renewal pack.
Unless you select one of these options we will not be able to send information on any of our other insurance policies or services.
We will not sell or pass your information to other organisations for marketing purposes.

CUE - Insurers pass information to the Claims and Underwriting Exchange register, run by Insurance Database Services Limited (IDS Ltd). 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 the register. When you tell us about an incident which may or may not give rise to a claim, we will pass information relating to it to the register. You can ask for more information about this.

IPT - Insurance Premium Tax
The Finance Act 1994 requires us to levy Insurance Premium Tax at the prevailing rate on insurance premiums. For further information, please ask us.

LAW APPLICABLE
The parties to the policy have the right to choose the law applicable to the Policy. Unless the parties agree otherwise English Law shall apply

The policy is administered By
Graybrook Insurance Brokers Limited, 8 Chandlers Way, South Woodham Ferrers, Essex CM3 5TB
Web:www.graybrook.co.uk
Email:enquiry@graybrook.co.uk
Tel: 01245 321185 Fax: 01245 322240

Graybrook Insurance Brokers Limited is Authorised and regulated by the Financial Conduct Authority. Registered No. 595238

and underwritten By
Aviva Insurance Limited
Registered in Scotland No 2116
Registered Office: Pitheavlis, Perth, Scotland PH2 0NH
Authorised and regulated by the Financial Services Authority