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28288463/001/1.01/HL - 09:23 09\08\2021

Tesco Bank Home Insurance - Statement of Fact

Policy Number TI00001244989 Cover start date 26/08/2021
Please review all of the information and limits below. If you have not answered any questions honestly, withheld information or not selected the correct level
of cover to replace 'as new' your contents and valuables, personal possessions, specified items and bicycles, we may refuse to pay your claim, pay only
part of your claim and/or void your policy.

1. Your Details
Full name of policyholder Miss Carly Golbourn Address of the property to be insured 42 Beach Crescent
Address of policyholder 42 Beach Crescent Walney
Walney Barrow-in-Furness
Barrow-in-Furness LA14 3YA
LA14 3YA

Occupation of policyholder Midwife(man/woman) Full name of joint policyholder N/A

Employer's business Health Care - NHS Occupation of joint policyholder N/A

Date of Birth 15/03/1981 Employer's Business N/A

Telephone Number 07702 791160 Date of Birth N/A

2. General Information
1. My Home 6. You or any person usually living with you has
a) is owned by me and/or my spouse/civil partner Yes a) made any claim within the last 5 years in connection No
b) is self contained Yes with your home insurance
c) has its own lockable entrance door Yes b) ever had cover refused or cancelled or made void No
d) is regularly occupied at night Yes
e) is regularly unoccupied during the day No c) any undischarged bankruptcies or criminal No
f) is never left unoccupied for more than 60 days Yes convictions (non-motoring), or any pending
convictions, excluding convictions spent under
g) Number of adults (people 18 or over) in the home 3
the Rehabilitation of Offenders Act 1974
h) Number of children (people under 18) in the home 2
7a) Number of bedrooms in the home 4
(A bedroom means a room used as or originally built to be a
2a) The walls of the building are constructed from Yes bedroom, even if it is now used for something else)
brick, stone, concrete, flint or metal
b) Number of bathrooms in the home 2
b) The roof is constructed from slates, tiles, metal or Yes
concrete 8. Year the home was built 1930
c) Approximate percentage of total roof area of the Under 33% (approximate date if exact year unknown)
home that has a flat roof 9. The property is a listed building No
3. The building is
10. The home is: Semi-Detached
a) in a good state of repair Yes
11. When this policy first started, you had lived at your 4 Years
b) not undergoing any building work unless agreed Yes address for
by us in writing 12. Ownership Type Owned
c) free from signs of and has never been damaged by Yes
subsidence, heave, landslip, tree root damage and 13. Number of Years with No Claims Discount 5
neighbouring subsidence
d) has never been flooded, isn't subject to any Yes
existing flood warning and isn't in an area at risk of
flooding
4. The whole of the building is occupied solely by Yes
me and members of my family unless agreed by
us in writing
5. The building is NOT used in full or part for, any Yes
business use with the exception of childminding and
clerical work whether by me or any other person
unless agreed by us in writing

If No to either 2 a or b please refer to additional

information at the end of this document

If Yes to either 6 a, b or c please refer to additional

information at the end of this document

Tesco Bank Home Insurance and optional add on cover products are arranged and administered by Tesco Bank acting as an insurance intermediary. Tesco Bank Home Insurance is underwritten by Tesco Underwriting
Ltd., London Court, 39 London Road, Reigate, Surrey RH2 9AQ. Add on cover is underwritten by a select range of insurers.
Tesco Bank is a trading name of Tesco Personal Finance plc. Registered in Scotland No. 173199. Registered Office: 2 South Gyle Crescent, Edinburgh EH12 9FQ.
Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. We may monitor and record calls for training purposes, to improve the
quality of our service and to detect and prevent fraud.
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3. Buildings
1. Cover required Yes
2. Maximum Claim Limit Unlimited
3. Accidental Damage cover required Yes

4. Contents
1. Cover required Yes 4. Valuables are as follows; jewellery, watches, items of gold,
silver or any other precious metal, stamp, coin or medal
2. Total replacement value as new up to £100000 collections, pictures, other works of art and furs
3. Accidental Damage cover required Yes
a) The replacement value as new of all valuables exceeds No
the maximum value shown on the schedule

5. Personal possessions
UK Cover and up to 60 days when you're abroad (optional cover available with contents cover)
The level of Personal possessions cover you have selected is in addition to your contents total replacement value

This covers items that you or your family wear or normally carry Your personal possessions are covered up to £0
around with you including baggage, clothing, jewellery, watches,
binoculars, sports equipment, musical and photographic Cover required No
equipment and furs. Cover is provided for loss or damage
anywhere in the UK and for up to 60 days when you're abroad.

In addition Money is covered up to £500. Mobile phones

are covered up to £600 and Credit Cards are covered up to £500. Any
items worth more than £2,000 need to be noted as a Specified
item, if cover is required away from the home.

6. Specified items
UK Cover and up to 60 days when you're abroad (optional cover available with contents cover)
The total value of items you have specified is in addition to your contents total replacement value

This covers items that you or your family normally wear or normally carry Cover required No
around with you that are worth more than £2,000. Specified items you wish to be covered
If you require cover for these items outside your home in the UK
and for up to 60 days when you're abroad then you must specify Description Value
the items under this section.

7. Bicycle cover (optional cover available with contents cover)

The bicycle cover you have selected is in addition to your contents total replacement value

This option extends your cover to include loss or damage to bicycles Cover required No
away from the home up to £2,500 in total.

A maximum claim limit of £1,000 per bicycle applies.

8. Security
The final exit doors have 5 lever mortice locks and the Yes The home has an alarm None
windows have key operated window locks

9. Policy excess
Please refer to your Policy Schedule for full details of your excesses.

In the event of a claim, you will be responsible for paying the excesses as shown in your schedule. This is the voluntary and compulsory excess amounts
added together and any additional excesses shown within your endorsements, if applicable.
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Important Notes
It is essential that you read the above information as it represents a record of your answers to our questions and, together with the policy booklet
and Policy Schedule constitutes your contract of insurance. Please keep all these documents in a safe place. You must advise Tesco Bank
immediately if any of the information is incorrect, is missing, has changed or will change. As a result of the change, your premium may increase or
decrease and the cover may be amended, depending on what the change is. Following any changes Tesco Bank will advise you of any adjustment
(if applicable) to your premium or any additional terms.

Disclosure and Representation

You have a legal obligation to take reasonable care not to make a misrepresentation to us, either directly or by providing answers to questions via
Tesco Bank. You must therefore have answered all of the questions that you have been asked by Tesco Bank honestly and must have not withheld
any information. If you have not answered any questions honestly or if you have withheld information, this may affect the cover you have, whether
or not you can make a claim and the terms and conditions of the policy (including the premium we charge). This could also invalidate your
insurance altogether. You must check all of the details in this Statement of Fact as by taking out or renewing your policy, you are confirming all of
these details are correct.

Insurance Registers and Databases

We may share information which we hold and which has been supplied to us in connection with any application for insurance that you have made
or any insurance policy which you have with us (including the renewal of any policy which you have with us) with the Claims and Underwriting
Exchange register, run by the Insurance Database Service Limited (IDS Ltd) and other similar databases or fraud prevention agencies established
for the same purpose. The aim is to help us check information that is given to us and to prevent fraudulent claims. When we process your request
for insurance cover or when you make a claim, we may search these registers.