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DUPLICATE

Policy Schedule
Forming part of Policy No:

The Insured:

XSG1GROV0003912

Mr Claudiu Ioan Botezatu


28 The Circle, London, NW2 7QS

Occupation:

Builder

Effective Date from the commencement of Insurance:


Date of the Expiry of Insurance:
The Vehicle:

Make & Model:


Body:
CC:
Value:
Year:
Registration No:
Cover:
Authorised Drivers:

Reason for Issue:

00:00
23:59

12/12/2016
11/12/2017

MERCEDES-BENZ S 350 L BLUETEC CD


Saloon
2987
33000
2013
WD13BLJ
Comprehensive
The Insured Only

Renewal

Total Excess:
3000 All Sections Excess for All Drivers
50 Windscreen Excess

Endorsements Applicable:

Insurer Address:
Calpe Insurance Company Limited Alwyn Insurance Company Limited
Grand Ocean Plaza, PO Box 1338 Grand Ocean Plaza, PO Box 1338
Gibraltar
Gibraltar

Client Policy Reference:


Date of Issue:
Agent Details:

BOCI01PC02
05/01/2017
Grove and Dean Ltd

Watford Insurance Company Europe Ltd


Grand Ocean Plaza, PO Box 1338
Gibraltar

Net Premium:
Insurance Premium Tax:
TOTAL PREMIUM:

1277.31
127.73
1405.04

DUPLICATE

Certificate
Certificate No:

XSG1GROV0003912

WS 50

1. Registration of Vehicle:

WD13BLJ

2. Policyholder:

Mr Claudiu Ioan Botezatu

3. Effective Date from the commencement of Insurance:

00:00

12/12/2016

4. Date of the Expiry of Insurance:

23:59

11/12/2017

5. Persons or classes of persons entitled to drive


The Insured Only

6. Limitations as to Use
Use for social, domestic and pleasure purposes only excluding travel to and from a place of work or study, any business use.
The policy does not cover:
Commercial travelling, use for hire, the letting on hire, the carriage of passengers or goods for hire and reward, racing, pacemaking, use in any contest, reliability or
speed trial or use on any purpose in connection with the motor trade other than use necessitated by overhaul, upkeep and/or repair of the vehicle insured under this
policy.

Declarations/Statement
I hereby certify that the policy to which this certificate relates satisfies the requirements of the relevant law
in Great Britain, Northern Ireland, the Isle of Man, the Island of Guernsey, the Island of Jersey, and the
Island of Alderney.
Chris McCann, For Authorised Insurers
Calpe Insurance Company Limited
Grand Ocean Plaza, PO Box 1338
Gibraltar

Alwyn Insurance Company Limited


Grand Ocean Plaza, PO Box 1338
Gibraltar
Watford Insurance Company Europe Ltd
Grand Ocean Plaza, PO Box 1338
Gibraltar

Several Liability Clause


The liability of each insurer to the policyholder is several, that is, limited to its participation under this policy and does
not extend to the liability of any other insurer, under this policy to the policyholder.
This Certificate of motor Insurance takes the place of an international Motor Insurance Card (Green Card) and is evidence
that the insurance extends to include the compulsory requirements of:
A) any member country of the European Union
B) Andorra, Croatia, Faroe Islands, Gibraltar, Monaco, Norway, Iceland, Liechtenstein, San Marino and Switzerland.
Cette attestation d'assurance automobile remplace la carte d'assurance automobile internationale (carte verte).
El certificado del seguro de automviles que le fue presentado reemplaza a la Tarjeta Internacional del seguro de
automviles (la Tarjeta Verde).
Die Ihnen ausgehndigte KFZ-Versicherungsbesttigung tritt an die Stelle des internationalen
Versicherungsscheins (der grnen Karte).

Client Policy Reference:


Date of Issue:
Agent Details:

BOCI01PC02
05/01/2017
Grove and Dean Ltd

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