User guide

This plan su
t
he insura
I
nsurance Prov
Domesti
S
ignif
contra
t
he co
•
B
Pleas
exp
Statement of pr
such as premiums and ta
Significant Ex
covered by yo
Conditio
limitations to yo
• Breakd
m
anufac
•
If your ap
beyond eco
and yo
What we wi
Age of Equ
Over 5 ye
Over 6 and up to 7 ye
Over 7 ye
*The curren
and if we canno
receive vo
•Deliv
•Any co
•Costs ar
•Cosmeti
•Acciden
Duratio
commence at th
for a pe
your ap
ensure it remains ad
Cancella
• You may can
receiv
repair yo
be du
replac
• You may can
cancella
will ap
a) If you ca
and yo
you a fu
b) If you can
has ru
part of th
months of co
c) If you ca
refund wi
Sum
of th
R
ead and complete Section A and Section B and return this form in an envelope to:
V
ax Guarantee Department, c/o Domestic & General Insurance PLC, Leicester House,
1
7 Leicester Street, Bedworth,Warwickshire, CV12 8JP.
Section B - Insurance Details and Payment Method
I
nsurance Details
P
eriod of protection required - additional 2 years additional 4 years Fee £
P
ayment Method
I
wish to pay by direct debit over 10 months (please complete mandate below)
I
enclose a Cheque/Postal Order payable to Domestic & General Insurance PLC
.oNeussIetaDyripxErebmunortseaM/atleD/asiV/dracretsaMymegrahcesaelP
D
eclaration I confirm that I have read Sections A and B and I hereby apply for the Vax Insurance Plan in accordance with the
t
erms and conditions of your plan. I confirm that the equipment is in good working order and used for domestic purposes only
and declare that the details in this proposal are true and complete to the best of my knowledge and belief.
Signature Insurance Purchase Date
Warning:Any false statement may render your plan invalid
DIRECT DEBIT PAYMENT PLAN
Instructions to your Bank or Building Society to pay by Direct Debit
Reference Number - for office use only Originators ID. No.
Instruction to your Bank or Building Society
Please pay Domestic & General Insurance PLC Direct Debits from the account detailed in this instruction subject to the
safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Domestic & General
Insurance PLC and, if so, details will be passed electronically to my Bank/Building Society.
To The Manager Bank Building Society
Address
Postcode
Name(s) of Account Holder(s)
Bank/Building Society Sort Code Account Number
DOMESTIC & GENERAL INSURANCE PLC OFFICIAL USE ONLY
This is not part of the instruction to your Bank or Building Society
If you have a preferred collection date from your account (1st to the 28th only) please complete this section
Signature Date
Banks and Building Societies may not accept Direct Debit Instructions for some types of account
997050
L
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