LVVTA Certifiers Renewal Declaration » i2i Insurance Brokers

About You

Your Name

Your Postal Address

Your Email Address

Please provide an email address that you use frequently

Your Mobile Number

For SMS Renewal Reminders

Do you practice as a:

Sole Trader

Partnership

Limited Company

Claims History

Have you ever had any claims brought against you?

Yes

Have you ever had any disputes in your fees?

Yes

How would you like to pay your premium?

You can pay monthly which incurs finance and interest charges or pay your premium via Internet Banking or Post your cheque on receipt of our invoice

Is there anything else that should be brought to the attention of the Insurers (NB a material fact is one likely to influence acceptance or assessment of this questionnaire by the Underwriters. If in doubt, disclose)

Declaration and Acceptance

I am/ We are an authorised LVV Certifier bound by the LVVTA Constitution, Bylaws and agree to be bound by them

I/We agree and accept that I/We declare and warrant that the information I/We have provided in this application is correct, truthful and complete; and that this application will form the basis of the contract between me/us and the Insurer

I further acknowledge that the LVVTA Certifiers Scheme is only applicable to my business activities as an LVV Certifier member under the Low Volume Vehicle Code

By ticking this box you agree you have signed your approval of the information disclosed and the use of I/We Accept is as reliable as is appropriate given the purpose for which, and in the circumstances in which a signature is required

i2i Insurance Brokers

LVVTA Certifiers Liability Insurance

Your Insurance policy is due to renew shortly.

About You

Claims History

Declaration and Acceptance

By ticking this box you agree you have signed your approval of the information disclosed and the use of I/We Accept is as reliable as is appropriate given the purpose for which, and in the circumstances in which a signature is required

i2i Insurance Brokers

LVVTA Certifiers Liability Insurance

Your Insurance policy is due to renew shortly.

About You

Claims History

Declaration and Acceptance

By ticking this box you agree you have signed your approval of the information disclosed and the use of I/We Accept is as reliable as is appropriate given the purpose for which, and in the circumstances in which a signature is required

Would you like to pay online?