Vintage Insurance Proposal Form Page 3
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3VINTAGE AND LIGHT SOCIAL, DOMESTIC AND
PLEASURE USE DECLARATION
Company:
Clan Insurance
Policy No:
02537452/22/01
Insured:
__________________________
Vehicle Make/Model:
__________________________
I sign below to state that the above vehicle will be used mainly for the purpose of Vintage
use, going to and from a Vintage Rally/Show or to partake in an Event.
I understand that I am covered for Light Social, Domestic and Pleasure Use, however this
vehicle will not be used as my main vehicle to which I have supplied my insurance details.
Signed:
Date:
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