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REF: 00-COSX14MT06 Open PrintManager Documents->sofdec (COSX14MT06).pdf
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                                                     York Street
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                    Broadsure Direct 4th Floor, The Argyle Centre ele Centrgy, The Arect 4th Floor
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                                                      CT11 9DS
                    Telephone :01843 594477                                          Fax :01843 594488
                    Policyholder:Mr Simon Cordell
                    Policy ref:COSX14MT06
                                                                                          Buildings  and  Contents
                                                                                                  and
                                                                                                     Contents
                                                                                          Buildings
                                                                                          Buildings and Contents
                    STATEMENT OF FACT (v1.02)
                                                                                            Trades and LiabilitiesLiabilities
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                    Please note that the documents enclosed relate to a "Statement Of Fact" insurance policy. This
                    means that Broadsure Direct have prepared the documentation on your behalf, based on the
                    information provided by you.                                                         HGV
                                                                                                         HGV
                    It is vitally important that you check all the enclosed documentation to ensure that it is correct and
                    that the policy meets your requirements. Please complete & return either declaration below within  V V Vans
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                    seven days.
                    I have checked the Statement Of Fact and all related documentation that the information is correct  F Fleets tslee
                    and the policy meets my requirements.
                                                                                                   Motortrade
                                                                                                   Mo t or tr ade
                    Signed ________________________ Print ___________________________________
                    Date ___/___/___                                                             Imported Cars sted Carporm
                                                                                                 I
                                                                                                    Motorcycle
                    I UNDERSTAND THAT SHOULD ANY OF THE INFORMATION WITHIN                            t or cy cle
                                                                                                    Mo
                    THIS STATEMENT BE INCORRECT, IT IS MY RESPONSIBILTY TO
                    CONTACT BROADSURE DIRECT IMMEDIATELY ON 01843 594477 AND
                                                                                                   Classic Cars slassic Car
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                    OBTAIN CONFIRMATION THAT THESE AMENDMENTS HAVE BEEN
                    COMPLETED.
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             Authorised and Regulated by the Financial Services Authority.  Member of the Institute of Insurance Brokerss
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