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QBE Endorsements attaching to the Commercial Vehicle and Fleet

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QBE Endorsements attaching to the Commercial Vehicle and Fleet Powered By Docstoc
					                               New Business Notification Form –
                                      Individual Risks

Today’s Date:                        ...................................................................................................................................

                  Insured                                                                                Address




Occupation:                          ...................................................................................................................................

Inception:                           Time: ......................................................... Date: .......................................................

Covernote Number:                    ...................................................................................................................................

Broker:                              ...................................................................................................................................

Sub Agent (if applicable):           ...................................................................................................................................

Scheme (if applicable):              ...................................................................................................................................

Vehicle Details:                     Make/Model: ............................................. Reg. No: .................................................

                                     Year: ................................... No. of Seats: ......................Value: ................................

Cover:                               ...................................................................................................................................

Excess:                              ...................................................................................................................................

Use:                                 ...................................................................................................................................

Premium Breakdown:
                                     Top Line Value                                     £ ___________
                                     Sub Total NCB                                      £ ___________
                                     Sub Total Load/Other                               £ ___________
                                     Total:                                             £ ___________                                  + IPT

Commission:                          ...................................................................................................................................

Finance Arrangement:                 ...................................................................................................................................

Additional Information:              ...................................................................................................................................

FSA Client Classification:           Retail                                             Commercial

Please advise whether the client is classified as a Retail Customer or Commercial Customer for the purpose of the ICOB. Please
include reference to mixed use classifications where appropriate



Motor Insurance Database (MID)
You must ensure that all policy and vehicle details are notified to Underwriters as soon as cover is issued to satisfy
the requirements of the MIIC.
With this is mind, this form must be completed and either faxed or e-mailed to the Fleet Renewals Section as soon
as cover is issued.

We look forward to receiving the renewal closing during the course of the next 7 days.


Email to fleetnewbiz@uk.qbe.com

Fax to QBE Fleet Department (New Business Section) – 01245 272711
                    QBE Insurance (Europe) Limited is part of QBE European Operations, a division of the QBE Insurance Group.
                          QBE Insurance (Europe) Limited is authorised and regulated by the Financial Services Authority.
             Registered office Plantation Place, 30 Fenchurch Street, London EC3M 3BD. Registered in England and Wales No. 1761561.


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