Certificate.pdf

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ERS
52-54 LEADENHALL STREET, LONDON, EC3A 2BJ
SCHEDULE NO:
IMPORTANT:
This Schedule (which replaces any previous issue) forms part of the insurance Document and applies in
conjunction with such Document, the current Certificate of Motor Insurance, and endorsement appendix attached or previously
applied.
Document No:
33455768
Period of insurance commencing:
Expiring:
15th November 2016 15:15
14th November 2017 23:59
Insured:
Mr Michal Rydz-Niczyporuk
Flat 12
Kenny House
38 Birse Crescent
London
NW10 1SF
Age at last renewal/inception:
17/11/1959
Occupation or Business:
Plumber
INSURED VEHICLE(S)
Make and Model
MERCEDES-BENZ E 240 AVANTGARDE
CC/KG
2597
Year
2000
Value
£1250
Registration No.
X965 CLF
Cover
(as defined in the
Insurance Document)
Third Party Only
ENDORSEMENT(S) APPLICABLE -
as indicated below (please refer to the Insurance Document or endorsement appendix for full wording)
Endt
No
I61
Value
Text
Name
Regulatory status
The Financial Services Authority (FSA) ceased to operate on the 1st of April 2013. From this date onwards our
regulatory status is as follows:
ERS (Syndicate 218 at Lloyd's) is managed by ERS Syndicate Management Limited, which is authorised by the
Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority.
(Registered number 204851.)
ERS Syndicate Management Limited is registered in England and Wales number 426475. The registered office is 52-54
Leadenhall Street, London EC3A 2JB.
REASON FOR ISSUE:
New Business
CLIENT REFERENCE:
RYMX16PC01
£1545.45
£154.55
£1700.00
Page 1 of 1
BROKER
AGENCY No:
SCHEME:
Complete Cover Group
13489
5597 ERS Special Risks PC Reserved
PREMIUM:
INSURANCE TAX:
TOTAL PREMIUM:
CERTIFICATE OF MOTOR INSURANCE
Certificate No.
33455768
1. Description of vehicles.
X965 CLF
2. Policyholder.
Mr Michal Rydz-Niczyporuk
IMPORTANT
3. Effective date of the commencement of insurance
Note:For full details of the insurance
for the purposes of the relevant law.
cover reference should be made to the
policy. If the wording of this
certificate includes the driving of
another vehicle, this will be shown
in the "persons or classes of person
entitled to drive" section of this
certificate and cover in respect of any
vehicle covered under the extension
will be for THIRD PARTY risks
only. If this is not shown within that
section then you do not have the
cover.
To ensure full protection under your
policy it is essential to notify your
broker of any changes to the details
previously supplied such as (a) change
of address, occupation, vehicle(s)
declared or use of your vehicle (b) the
drivers
covered
(especially the
inclusion of any person under 25 years
of age), (c) motoring convictions
and/or summons, pending/accidents/
physical conditions or any person
likely to drive.
IMPORTANT THESE NOTES
ARE FOR YOUR GUIDANCE
15:15
23:59
15th November 2016
14th November 2017
4. Date of expiry of insurance.
5. Persons or classes of persons entitled to drive.
The Policyholder Only
The Policyholder may also drive a private motorcar not belonging to him/her and not hired to him/her under a
hire purchase or leasing agreement, as long as the policyholder has the owner's permission to drive the car.
Provided that the person driving holds a licence to drive the vehicle or has held and is not disqualified
for or prohibited by law from holding or obtaining such a licence.
6. Limitations as to use.
Use only for social, domestic and pleasure purposes excluding use by any person for travelling to and
from his/her place of work/business or study.
WARNING
If any person for the purpose of
obtaining the grant of any licence to
himself/herself or any other person
knowingly
makes
any
false
statements, or for the purpose of
obtaining the issue of a certificate
of insurance or of a certificate of
security under the relevant law
applicable
in
Great
Britain,
Northern Ireland, the Isle of Man,
the Island of Guernsey, the Island
of Jersey and the Island of Alderney,
makes
any false statement or
withholds any material information,
he/she shall be liable to a fine not
exceeding fifty pounds or to
imprisonment for a term not
exceeding six months or to both
such imprisonment and fine.
If you wish to cancel the policy you
must return the certificate. If this
certificate refers to a specific vehicle
and you are replacing your vehicle,
this certificate must be returned to
your broker.
Where the driving other vehicles extension is shown under section 5 of this certificate of insurance this policy does not
cover use to secure the release of a motor vehicle, not otherwise specifically the subject of insurance by this policy,
which has been seized by, or on behalf of, any government or public authority.
The policy does not cover use for hiring, the letting on hire, the carriage of passengers or goods for hire or reward,
racing, pacemaking, use in any contest, reliability or speed trial, or use for any purpose in connection with the motor
trade, except where included in 6 above.
I hereby certify that the policy to which this certificate relates satisfies the requirements of the relevant law applicable in
Great Britain, Northern Ireland, The Isle of Man, The Island of Guernsey, the Island of Jersey and the Island of Alderney.
For and on behalf of the Underwriter subscribing ERS,
52-54 Leadenhall Street, London, EC3A 2BJ
Authorised Insurers
Mark Bacon
Active Underwriter
Note: For full details of the insurance cover reference should be made to the policy.
ADVICE TO THIRD PARTIES - NOTHING CONTAINED IN THIS CERTIFICATE AFFECTS YOUR RIGHTS
AS A THIRD PARTY TO MAKE A CLAIM.
EUROPEAN UNION (EU) (COMPULSORY COVER)
Dieses Zertifikat der Kfz-Versicherung ist ein Beweis, dass diese Versicherung die Kfz Haftpflichtversicherungs
anforderungen von allen Mitgliedsländern der Europäischen Union und Andorra, Island, Norwegen, Serbien und der
Schweiz (einschließlich Liechtenstein) erfüllt.
Este certificado de seguro de automóviles es evidencia de que este seguro cumpla conl os requisitos de seguro obligatorio de
automóviles de todos los países miembros de la Unión Europea y Andorra, Islandia, Noruega, Serbia y Suiza (incluido
Liechtenstein).
Questo certificato di assicurazione auto è la prova che questa assicurazione soddisfa i requisiti di assicurazione obbligatoria
degli autoveicoli di tutti i paesi membri dell Unione europea e Andorra, Islanda, Norvegia, Serbia e Svizzera (compreso il
Liechtenstein).
%
Windscreen Excess
%
%
%
%
%
THIS
CERTIFICATE
OF
MOTOR INSURANCE HAS
BEEN PREPARED ON A
LASER PRINTER AND IS NOT
VALID IF IT HAS BEEN
ALTERED IN ANY WAY
This certificate of motor insurance is evidence that this insurance meets the compulsory motor insurance requirements of all
member countries of the European Union and Andorra, Iceland, Norway, Serbia and Switzerland (including Liechtenstein).
Ce certificat d assurance automobile est une preuve que cette assurance est conforme aux exigences de l assurance
automobile obligatoire de tous les pays membres de l Union européenne et l Andorre, l Islande, la Norvège, la Serbie et la
Suisse (y compris le Liechtenstein).

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