Insurance Statement of Facts

Statement of Facts for Motor Insurance
Arranged by Lexham Insurance Consultants Ltd with Alwyn Insurance Company Ltd
Policy Number (if known) LIC/MC/0418743 Lexham Ref 454392AASC
Important – You should take time to read the following notices and details, and to check that all the information contained in this
Statement of Facts is true and accurate to the best of your knowledge and belief. We may require additional premium and/or excesses or
even void the contract and not pay a claim if any of the details are found to be incorrect.
This contract is with the person named below personally (“You”). It is your responsibility to ensure all information supplied in connection with
this contract and any claim under it is correct. Marble Arch work on behalf of Alwyn Insurance as a Claim Administrator, with delegated
authority to handle their claims. Marble Arch is a trading name of Lexham Insurance. If you wish anyone else to deal with any aspect on your
behalf, you must arrange this specifically with Lexham or the Claim Administrator, but they may still contact you if these arrangements are not
effective or satisfactory. If you have any particular needs, please tell Lexham Insurance or the Claim Administrator - they will assume you have
none if they are not told.
This Statement of Facts is a record of information given by you and forms part of the contract of motor insurance between you and Alwyn
Insurance Company Ltd. If you are satisfied that, to the best of your knowledge and belief (after making any appropriate enquiries, e.g., of anyone
else who will be covered by this insurance), all statements are true and complete, you need take no further action, simply retain this statement in a
safe place along with your other policy documents. If you know or believe any of the information on this form to be incomplete or incorrect,
please contact Lexham immediately – you will then be advised of any changes in the premium or terms and a revised Statement of Facts will be
issued to you. Failure to do so could invalidate your insurance.
Lexham Insurance Consultants Ltd, Unit 21, Hopper Way, Diss, Norfolk IP22 4NG 01379 646510 [email protected]
Authorised and regulated by the Financial Conduct Authority, firm reference number: 303917
Your Details
Full Name Mr Mohammed Sehab Uddin Contact Numbers
Full Address 38 Crossbrook Road Marital Status Married Home 07361522510
London
Kent Gender
SE3 8LN
E-Mail Address [email protected]
Insurance Cover
Cover to commence at 00:01:00 on 29/05/2024 to 23:59:00 on 28/05/2025
Type of cover Third Party Voluntary excess £0
Driving restriction Insured Only No Claims Bonus Protection required (if available) No
Vehicle Details
Make and Precise
HONDA PCX 125
Model
Cubic Capacity 125
Registration
GX65XFF
number
Year of first
2015
registration
Purchase price £1020
Purchase date 01/05/2024
Estimated
£1020
Market Value
Has the vehicle No
been imported?
Is a Sidecar fitted No
to the vehicle?
Estimated annual
4000
mileage
Current odometer
0
reading
Proposer/Policyho
Vehicle owned by
lder
Proposer/Policyho
Registered keeper
lder
SECURITY
Lexham Insurance Consultants Ltd
Unit 21, Diss Business Hub, Hopper Way, Diss, Norfolk, IP22 4NG Tel: 01379 646504 Email: [email protected]
Authorised and regulated by the Financial Conduct Authority, FRN: 303917 Registered Office: As above Registered in England No. 3897329
Page 1 of 9 V6 - 07/23
Whenever your bike is left unattended (including while in a locked garage), cover against theft will apply only if the bike is secured with at least
one of a D-Lock, Disc Lock, Grip Lock or an armoured chain plus any other lock on the bike (such as a steering lock).
Are there any other security or tracking devices fitted and in operation on this vehicle? If ‘Yes’ provide details below Yes
Details of any security or tracking devices fitted to the vehicle

Security Device Installer Cert Seen Indicator
Yamaha Y.I.S.S No
No
No
Has your vehicle been modified, altered or adapted in any way from the manufacturer’s standard specification, including any manufacturer or
dealer fitted options whether or not performance is altered? (e.g., changes to bodywork, artwork, suspension, brakes)?
No If ‘Yes’ provide details below
If you intend to modify the vehicle throughout the course of this insurance policy term, please contact us before carrying out any changes to
ensure that the modification is acceptable and to calculate any additional premium or charges.
Details of any Modifications to the Vehicle
Modification Type Modification Value (£)
Does the vehicle have any accessories fitted, including any manufacturer or dealer fitted options, whether or not performance is altered?
Accessories
Value (£) Description Value (£) Description
Address at which the vehicle 38 How is the bike normally kept while at this address? Garage
is usually kept Crossbrook Road
London Might you carry passengers on the bike? No

Kent
SE3 8LN
Cover may be affected or invalid if the bike is not garaged when at this address. Check with Lexham for further details.
Details of All Persons Who Will Drive the Vehicle, Including Yourself
Mr Mohammed Sehab
Full Name
Uddin
Marital Status & Gender Married
Date of Birth & Age 15/06/1994 age: 29
Type of driving licence held Provisional (UK)
Period driving licence held (years) 3
Date driving test passed 30/03/2021
State when last driven regularly in the UK
Does this driver hold a valid Compulsory Basic
Yes
Training (CBT) certificate?
Occupation (1st occupation) Health Care Assistant
Nature of employers’ business (1st occupation) Health Care - NHS
Employment Status (1st occupation) Employed
Occupation (2nd occupation if applicable)
Employers’ business (2nd occupation if
applicable)
Employment Status (2nd occupation if applicable)
Relationship of this driver to the Proposer Proposer
Are you the Main User of this vehicle? Yes
Nature of this driver’s use of this vehicle? Social, Domestic And
Pleasure
Does this driver own another vehicle? No
Does this driver have use of another vehicle? No
Ever been convicted of any non-motoring
offence, including offences relating to theft, fraud No
or dishonesty?
Any prosecution or police enquiry pending? * No
Have you ever been disqualified from driving? * No
Ever been declined or refused any type of
No
insurance or had any special term imposed? *
Have you ever had previous terms applied? * No
Restrictions to licence No Restrictions
* If answered ‘Yes’ please give full details in additional information
IT IS YOUR RESPONSIBILITY TO ENSURE THAT YOU AND ALL NAMED DRIVERS HOLD A VALID DRIVING LICENCE(S)
AND/OR CBT CERTIFICATE (IF APPLICABLE) FOR THE VEHICLE(S) YOU ARE PROPOSING TO INSURE.
FAILURE TO HOLD A VALID LICENCE FOR THE VEHICLE YOU ARE RIDING WILL MAKE THIS INSURANCE INVALID
AND ALL COVER WILL STOP FROM THE START OF THE CONTRACT.
WE RESERVE THE RIGHT TO REQUEST A COPY OF ANY DRIVER’S LICENCE AT ANY TIME.

Page 2 of 9 V6 - 07/23
Qualifications
Have you (or any named rider) passed an advanced rider qualification? No If ‘yes’ please state the qualification below.
Rider Name Qualification Description Date Obtained
Mr Mohammed Sehab Uddin
Claims
Have there been any accidents, claims or losses (including fire and theft), irrespective of blame and whether a claim was made or not, during the last five
years in connection with any motor vehicle (including private cars or commercial vehicles) owned or ridden by you or by any person who to your
knowledge will ride? No If ‘Yes’, give details below.
Rider Name Date Claim Type Claim Status NCD Affected* At fault?
* or would have been, if it had not been for No Claims Discount Protection
Convictions (including fixed penalties)
Have you or any person who to your knowledge will ever ride been convicted of any motoring offence, including any fixed penalty notice, or
have any licence endorsements in connection with any motor vehicle? No
If ‘Yes’ give details below.
Rider Name Date Motoring Offence Alcohol Reading Fine Penalty Disqualification
Code (if any) (£) Points Period (Months)
Medical
Does any driver suffer from a medical condition which may affect their riding or driving, or any condition for which DVLA have restricted the
licence? No If ‘Yes’ please provide full details below.
Rider Name Nature of Condition Date of onset DVLA notified?
All drivers must inform Drivers Medical Group, DVLA, Swansea SA99 1DL, at once, if they have any disability (including any physical or mental condition)
which may be likely to affect their fitness as a driver. If in doubt, refer to a doctor or the DVLA for advice.
Insurance History
Name of previous insurer Policy number
Number of years No Claims Bonus 3 Expiry Date 28/05/2024
Type of policy Motor Cycle
Additional information
IMPORTANT NOTES
This insurance will be provided by Alwyn Insurance Company Ltd (incorporated in Gibraltar no. 106261, authorised, and regulated by the
Gibraltar Financial Services Commission and the Financial Conduct Authority, firm reference number: 571591), P.O. Box 1338, First Floor
Grand Ocean Plaza, Ocean Village, Gibraltar. A member of the Financial Ombudsman Service and the Financial Services Compensation Scheme.
Marble Arch work on behalf of Alwyn Insurance as a Claim Administrator, with delegated authority to handle their claims. Marble Arch is a
trading name of Lexham Insurance.
All other aspects of administering this insurance contract are carried out by Lexham Insurance Consultants Ltd:
Unit 21, Hopper Way, Diss, Norfolk IP22 4NG 01379 646510 [email protected]
Authorised and regulated by the Financial Conduct Authority, firm reference number: 303917
English law will apply to this contract (or Scottish or Northern Ireland if you are resident in one of these jurisdictions).
For our mutual protection all our telephone conversations are recorded.
At the beginning of the insurance and at each renewal, we may check the information disclosed against various registers and databases.
We (including those we use to provide services related to this contract) will hold and maintain your personal data in accordance with data
protection legislation. We will never sell your personal data or use or supply it for any purpose other than:
- to enable us to administer and to meet our obligations under this contract.
- to assist authorised fraud prevention, law enforcement and similar agencies.
- to update the Motor Insurance Database (MID) and other approved databases.
- for any other use relevant to this contract.
Please ask Lexham Insurance if you have any questions relating to this insurance.
YOUR DECLARATION
I confirm that the answers to all the questions on this form are complete and true to the best of my knowledge and belief true (after making any
appropriate enquiries, e.g., of anyone else who will be covered by this insurance). If you misrepresent or fail to disclose information about which
you are asked, an insurance claim may not be covered, and your policy may be cancelled or voided from inception.
I confirm that the vehicle described is in roadworthy condition and no requested information has been withheld by me (failure to provide such
information may result in the policy being invalidated or claims being rejected or not fully paid).
Page 3 of 9 V6 - 07/23
Proposer’s signature ……………………………………………. Date ……………………..
THERE IS NO NEED TO SIGN OR RETURN THIS FORM UNLESS YOU ARE CORRECTING ANY INFORMATION ON IT (though you
may inform Lexham by phone instead of returning this form).

Page 4 of 9 V6 - 07/23
ALWYN INSURANCE COMPANY LIMITED DATA PROTECTION NOTICE – CUSTOMERS
This Data Protection Notice contains the information You need to understand how Your personal data is used
by the Insurer and Intermediaries. If you would like more details, please go to www.archcapgroup.com (Data
Protection Policy) or www.lexhaminsurance.co.uk or contact us using the details in Section 11 below.
In this Data Protection Notice:

Insurer refers to Alwyn Insurance Company Limited.
Intermediaries refers to Lexham Insurance Consultants Ltd and its contractors, who arrange insurance cover
and handle Your claims.
You/Your refers to the policyholder or any other person insured or potentially insured by the contract or
potential contract. It is the responsibility of the person seeking the quotation or arranging the insurance to
convey the information in this Data Protection Notice to any other such person.
In order to manage our business and provide our services to customers, the Insurer and Intermediaries (we, us, our)
collect a certain amount of personal data. "Personal data" means data relating to a living individual who is or can be
identified either from the data or from the data in conjunction with other information.
This Data Protection Notice sets out the basis on which we gather, use, disclose and process any personal data we
collect from You, or that You provide to us. We will use Your personal data only for the purposes and in the manner
set forth below which describes the steps we take to ensure our processing of Your personal data is in compliance
with the General Data Protection Regulation ((EU) 2016/679) (the GDPR) and any implementing legislation.
Please read the following carefully to understand our use of Your personal data.
Your right to object – Please note that you have a right to object to the processing of your personal data where that
processing is carried out for our legitimate interests, but if you do this it may affect our ability to provide insurance to
you.
1. What personal data we may collect about you?

In order to provide insurance quotes, insurance policies and deal with any claims or complaints, we need to collect
and process personal data about you. If you do not provide the information we need, we may not be able to offer
you a quote or provide our services to you. The types of personal data that are processed may include:
Category Types of data collected

Individual details Name, address, gender, marital status, date of birth, nationality, marketing
preferences, bank account details or payment card details, vehicle details, relevant
criminal convictions, penalty points, employer, job title and family details, including
their relationship to you.
Identification details Identification numbers issued by government bodies or agencies, including your
driving licence number.
Credit and anti-fraud data Credit and anti-fraud data such as credit history, credit score, sanctions and criminal
offences, and information from various anti-fraud databases related to you.
Special categories of Certain categories of personal data which have additional protection under EU data
personal data and protection law. These categories are health and criminal convictions.
criminal convictions data
Claims information Information about previous and current claims (including other
unrelated insurances), which may include data relating to your health (e.g., injuries
and relevant pre-existing conditions), relevant criminal convictions, or other special
Page 5 of 9 V6 - 07/23
categories of personal data mentioned above.
Risk details Information about you which we need to collect in order to assess the risk to be
insured and provide a quote. This may include data relating to your health, relevant
criminal convictions, or other special categories of personal data.
2. The purposes of, and legal basis for, processing your personal data
We hold, disclose and process your personal data in order to provide you with insurance cover in accordance with our
contract and to take steps at your request prior to entering into a contract. This includes using your personal data
for:
 Quotation and inception.
 Policy administration.
 Claims processing; and
 Renewals.
We may also use your personal data where:
a) it is necessary to comply with our legal and regulatory obligations (for example, complying with reporting
obligations to the Financial Conduct Authority, the Prudential Regulatory Authority or other applicable
regulatory authorities).
b) it is necessary to support our legitimate interests in managing our business, including in connection with (i)
the administration of your policy, (ii) improving our insurance products and services, (iii) prevention and
detection of crime, (iv) general risk modelling, (v) transferring books of business, company sales and
reorganisations; (vi) analytics provided such interests are not overridden by your interests and rights; and (vii)
obtaining reinsurance; and
c) You have consented to processing your information in such a way.
3. Criminal convictions
The Insurer and Intermediaries may hold, use, disclose and process personal data relating to relevant criminal
convictions and offences for the purposes identified above, where necessary to comply with our legal and regulatory
obligations, or where necessary to support our legitimate interests. We will only carry out such processing where it is
authorised by European Union (EU) or Member State law.
4. Special categories of personal data

We hold, use, disclose and process special categories of personal data (e.g., your health data) where:
 you have given us your explicit consent.
 the processing is necessary to enable us to provide the service(s) you have requested or to protect your, or
another's vital interest.
 you have manifestly made your personal data publicly available.
 the processing is necessary for the establishment, exercise or defence of legal claims; or
 necessary for reasons of substantial public interest on the basis of law.
5. Who we share your information with

In order to provide our services and to comply with legal obligations imposed on us, it may be necessary for us to
disclose your personal data to third parties, including without limitation to the following:
 with the Insurer group, and our agents and third parties who provide services to us, your Intermediary and
other insurers (either directly or via those acting for the Insurer) to help us administer our products and
services.
 with regulatory bodies and law enforcement bodies (where we are required to do so to comply with a
relevant legal and regulatory obligation).
 legal, financial, medical and other professional advisors.
 with the Insurer's affiliates assisting with the operations of the Insurer; and
Page 6 of 9 V6 - 07/23
 with the Insurer’s reinsurers, who provide reinsurance services to the Insurer. Reinsurers will use your data
to decide whether to provide reinsurance cover, assess and deal with reinsurance claims and to meet legal
obligations. They will keep your data for the period necessary for these purposes and may need to disclose it
to other companies within their group, their agents and third party service providers, law enforcement and
regulatory bodies. To the extent the reinsurer is a member of the Insurer group and is subject to the GDPR,
the reinsurer will process your personal data where in its legitimate interests to do so. For further
information please visit www.archcapgroup.com.
6. Transfer of personal data outside the EEA

The personal data we collect from you may be transferred to, and stored at a destination outside of the European
Economic Area (EEA) for purposes described above. Those countries may not provide an adequate level of protection
in relation to processing your personal data. Due to the global nature of our business, your personal data may be
disclosed to members of our group outside of the EEA, including in particular Switzerland, Bermuda and the U.S.
However, to ensure that your personal data receives an adequate level of protection we have put in place the
following appropriate safeguards in place to protect the privacy and integrity of such personal data:
 Model Clauses: standard clauses in our contracts with our above-listed third parties to ensure that any
personal data leaving the EEA will be transferred in compliance with EU data-protection law. Copies of our
current Model Clauses are available on request by using the Insurers’ contact details listed in Section 11; and
 EU/Swiss-U.S. Privacy Shield: an agreement between the EU and the Governments of Switzerland and the US
concerning the treatment of data concerning EU citizens. Some of our third parties are certified under the
EU/Swiss-U.S. Privacy Shield.
7. How long we keep your personal data

We are required to ensure that your personal data, as a policyholder, is accurate and maintained in a secure
environment for a period of time no longer than necessary for the purposes for which we are processing your
personal data.
Where You purchase our insurance product, information will be held for the duration of your insurance cover and a
period of at least 7 years after the end of our relationship. We keep information after our relationship ends in order
to comply with applicable laws and regulations and for use in connection with any legal claims brought under or in
connection with your policy.
8. Automated decision making

You have a right not to be subjected to decisions based on automated processing, including profiling, which produce
legal effects concerning you or similarly significantly affects you. However, in certain circumstances we are entitled
to use automated decision-making and profiling. These cases are restricted to situations where the decision is
necessary for entering into a contract, or for performing that contract (i.e., your policy of insurance or quote), where
it is authorised by law or where you have provided your explicit consent. Where we use automated decision-making,
you will always be entitled to have a person review the decision so that you can contest it and put your point of view
and circumstances forward.
9. Your data rights

You have several rights in relation to your personal data. You have a right to:
 access a copy of your personal data held by us.

 request rectification of your personal data if it is inaccurate or incomplete.
 request erasure of your personal data in certain circumstances.
 restrict our use of your personal data in certain circumstances.
 move (or port) personal data which you have given us to process on the basis of your consent or for
automated processing.
Page 7 of 9 V6 - 07/23
 object to the processing of your data where our legal basis for processing your data is our legitimate
interests; and
 not to be subject to a decision based on automated processing, including profiling which has legal or similar
significant affects.
However, these rights may not be exercised in certain circumstances, such as when the processing of your data is
necessary to comply with a legal obligation or for the exercise or defence of legal claims. If you wish to exercise any
of your rights in this regard, please contact us using the contact details in Section 11. We will respond to your request
in writing, or orally if requested, as soon as practicable and in any event not more than one month after receipt of
your request. In exceptional cases, we may extend this period by two months, and if we do this, we will tell you why.
We may request proof of identification to verify your request.
10. Consequences of failure to provide information

If the Insurer or the Intermediaries cannot collect information requested from you, it may make it difficult,
impossible, or unlawful for us to give you advice on, provide you with, and administer our insurance products.
If the Insurer or the Intermediaries ask for information and you do not wish to give it to us, or if you wish to withdraw
consent to the use of your personal data, the Insurer or the Intermediaries will explain the consequences based on
the specific information concerned including whether it is a legal or contractual requirement that we use such data. If
you have any queries in respect of the consequences of not providing information or withdrawing your consent,
please contact the Insurer and Intermediaries using the contact details in Section 11.
11. Further information

If You require any further information about how we use your data or if you want to exercise any of your rights under
this Data Protection Notice, please contact the Insurer and Intermediaries as listed below:
Insurer Intermediaries
Alwyn Insurance Company Limited Data Protection Officer
PO Box 1338 Lexham Insurance Consultants Ltd
First Floor, Grand Ocean Plaza Unit 21, Hopper Way
Ocean Village, Gibraltar Diss
GX11 1AA Norfolk
Email: [email protected] IP22 4NG
Tel 01379 647885
Alwyn Insurance Company Limited is an insurance Email: [email protected]
company licensed by the Financial Services Commission in
Gibraltar (incorporation number 106261) and the Financial
Conduct Authority, firm reference number: 571591.
The Insurer and the Intermediaries encourage you to review this Data Protection Notice and explore the websites
below where additional information about the processing of your personal data may be found:
 www.lexhaminsurance.co.uk
 www.archcapgroup.com
If you wish to receive a copy of website information of the Insurer and/or the Intermediaries by post, please contact
the Insurer and Intermediaries as listed above.

Page 8 of 9 V6 - 07/23
12. Your right to complain to the ICO
If you are not satisfied with our use of your personal data or our response to any request by you to exercise any of
your rights in Section 9, you have the right to lodge a complaint with the Information Commissioner’s Office. Please
see the below contact details:
England Information Commissioner’s Office

Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF
Phone: 0303 123 1113 (local rate) or 01625 545 745 (national rate)
Email: [email protected]
Scotland Information Commissioner’s Office
45 Melville Street
Edinburgh
EH3 7HL
Phone: 0303 123 1115
Wales Information Commissioner’s Office
2nd Floor
Churchill House
Churchill way
Cardiff
CF10 2HH
Phone: 029 2067 8400
Northern Ireland Information Commissioner’s Office
3rd Floor
14 Cromac Place
Belfast
BT7 2JB
Phone: 0303 123 1114 (local rate) or 028 9027 8757 (national rate)
13. Important information about this data protection notice

Each Insurer and Intermediary providing this data protection notice to you is a separate legal entity and separate data
controller in respect of your personal data.

Page 9 of 9 V6 - 07/23

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Statement of Facts for Motor Insurance

Policy Number (if known) LIC/MC/0418743 Lexham Ref 454392AASC

Purchase date 01/05/2024

Details of any security or tracking devices fitted to the vehicle

London Might you carry passengers on the bike? No

Lexham Insurance Consultants Ltd

Lexham Insurance Consultants Ltd

In this Data Protection Notice:

1. What personal data we may collect about you?

Category Types of data collected

4. Special categories of personal data

5. Who we share your information with

6. Transfer of personal data outside the EEA

7. How long we keep your personal data

8. Automated decision making

9. Your data rights

 access a copy of your personal data held by us.

10. Consequences of failure to provide information

11. Further information

Lexham Insurance Consultants Ltd

England Information Commissioner’s Office

13. Important information about this data protection notice

Lexham Insurance Consultants Ltd

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