The Insured / Claimant
Is the Insured VAT registered?
If the person or organisation making this insurance claim (the Claimant) is not as named above, please provide the Claimant’s details below:
Is the Claimant VAT registered?
Does the Claimant have the benefit of any other insurance that may be relevant to the subject matter of this claim, e.g. other Legal Expenses Insurance, Professional Indemnity, or Public Liability Insurance?
If yes, please provide details of the policy
Statutory Licence claim details
Is the licence/registration in the name of the business/individual?
What stage has the issue with the licence reached? Have the authority / regulatory body made a decision that you want to appeal or are they still considering what decision to make?
Did the licence holder receive any warnings or notices or unsatisfactory reports prior to the authority/regulator taking action?
If yes, please provide details of previous notices
Has the licence been in issue before?
To enable your insurance claim to be assessed you must provide all correspondence and
documents relevant to your legal case. Below is a list of the key documentation you are likely to have for your claim, which you must send to us if it exists in your case.
Please upload the necessary correspondence /
documents or check the box if they do not exist.
Copy of your Policy Schedule
Relevant correspondence with the authority
A full copy of the Statutory Licence that is in issue
Any notice relevant (prohibition notice/warning, notice of proposal, Notice of Decision)
Please send larger documents separately by email or alternatively you may send physical documents via the postal system.
at the date of inception (or renewal) of this insurance that this claim, the details of which are set out above was liable to arise. aware/not aware
Please select one regarding the statement above:
We declare that all our statements within this claim form are true and complete.
We accept that making a fraudulent insurance claim is a criminal offence and the details may be passed to the enforcement authorities.
We request that Markel Legal Expenses Insurance deal with this matter in accordance with the terms and conditions of our Legal Expenses Insurance. We understand they will collect and use relevant information about us and any other individual’s details we provide to them, in respect of our insurance claim. This information may also be shared with third parties – but only in connection with the claim under the insurance cover. Full information on how Markel process your data can be found
We authorise Markel Legal Expenses Insurance to access and use, for the purpose of assessing this claim, the record(s) of our communications with the Legal Help Line. We also authorise Markel Legal Expenses Insurance to disclose information about this claim to the intermediary who arrange this insurance.
Check if you agree with all the statements above