Swansway Garages Limited

DEMANDS & NEEDS QUESTIONNAIRE & STATEMENT

In order to comply with the Financial Services Authority (FSA) Regulations, it is a requirement that all insurance product offerings are correctly explained to you and that they meet your individual needs. Our sales staff will based on your answers, provide you with relevant details about suitable products for you to consider. You will receive the original of this document once completed and signed with a copy being held at the dealership.

Customer Name (in block capitals) Commercial

Address

SECTION 1 – GAP INSURANCE

Will your vehicle have fully comprehensive motor insurance in your name? Yes/No

RETURN TO INVOICE INSURANCE If your vehicle is declared a total loss during the next 3 years does your motor insurance Yes/No policy pay anything other than the vehicle’s market value?

FINANCIAL SHORTFALL INSURANCE If your vehicle is a total loss and you owe more on your finance agreement than the sum Yes/No your insurance pays out would you be happy to make up the shortfall yourself?

SECTION 2 – PRODUCT CHOICE

RETURN TO INVOICE INSURANCE (RTI) This insurance will meet the demands & needs of those who wish to protect their original investment. In the event of the vehicle being declared a total loss and the Motor Insurer only paying the market value of the vehicle at the time of the loss RTI Insurance will make up the difference back to the original purchase price subject to the terms and conditions of the policy.

GUARANTEED ASSET PROTECTION (GAP) This will pay the difference between the write off value from your car insurer and your finance settlement figure subject to the terms and conditions of the policy.

SECTION 3 – DECLARATION I confirm that I have received a Key Facts Policy Summary and had the features, benefits and significant exclusions explained to me for the product(s) offered. I have also received a copy of Swansway Garages Ltd’s Initial Disclosure Document.

STATEMENT OF PRICE Product Premium Total Price inc Term of Customer’s Inc IPT Interest interest & cover Decision (If added to IPT Rental) RETURN TO INVOICE n/a n/a n/a n/a n/a INSURANCE

GUARANTEED Accept / ASSET 36 £199 One Payment £199 Decline PROTECTION Months

Date: Customer’s Signature:

Date: Salesperson’s Signature:

Office use only: Date: Signed by FSA Supervisor:

SGL-DNNA-V1-011208