Important please read and sign below 

I / We declare that:

To the best of my knowledge and belief all particulars give to Executive Insurance are true and complete and I have taken all reasonable steps to ensure their accuracy, and have made sure that anyone responsible for arranging our insurance has been included in the decision making process. I have not withheld or concealed anything that might influence the acceptance and/or assessment of the proposal of insurance.


I understand that if any details have not been disclosed to Executive Insurance at the inception of the policy then they will charge for the additional work done on my policy and this will be charged at an hourly rate of £75.00.

I understand that if any of the information changes in any way this could alter the premium originally quoted.  If there is an additional premium I / We will be liable for the difference in premium.  If there is a return premium, the return will either be credited to the credit agreement or if I have paid in full, the money will be credited back to the credit or debit card originally used as per our Terms of business.

I confirm that before I went on cover the member of staff confirmed that, as this is a commercial contract, my Insurer does not have a 14 day cooling off period.  If I cancel this insurance my deposit will be used as a time on risk charge.

  • I confirm Executive Insurance have brought to my attention endorsements and the subjectivity for this insurance contract.

  • I agree that all requested documents will be returned within the required time frames, and understand that failure to return the required documents may result in my policy being cancelled.

  • (For motor trade policies only) if requested, I will be able to provide proof of motor trade activities to prove that I am motor trading.  I understand that if I am unable to provide satisfactory evidence that I am trading as a motor trader, then my policy will be cancelled and I will be charged in line with Executive Insurance Terms of Business which I have read.

Instalment payments

If I have requested that my insurance is to be paid over monthly payments, before going on cover, Executive Insurance have confirmed to me that my premium would be paid by a Third Party Credit Provider who pays for my insurance.

The direct debit is a credit loan agreement, set up and administered by a Third Party finance provider.

In assessing your application, the finance provider may search the public information a credit reference agency holds about you.  The credit reference agency will add details of the search to their records whether or not an application for credit proceeds.  This and other information may be used to make credit decisions about you and to undertake checks for the prevention and detection of money laundering.

If you do not make the repayments that are due under the credit agreement then your credit rating may be adversely affected and could make obtaining credit more difficult in the future.  It may also result in legal action being taken to recover the debt.

If your first payment is not authorised, your policy will be cancelled and the deposit will not be refunded.  This is to cover the time on risk charge from the insurer and to cover the cost of setting up your policy.