Agreed Value and Vehicle Condition Form

Asset Trust Group
Trull Barn
Trull Farm
Tetbury
Gloucestershire
GL8 8SQ

Telephone: 01285 841555
Fax:01285 841505

Name	Policy Number
Address	Renewal date

Manufacturer	Year of Manufacture
Model	Date and Cost of Purchase
Type of Body	Registration Number

Vehicle Appraisal (please insert First Class/Good/Servicable/Requires Attention)
Body Condition	Engine and Transmission
Chassis/Frame	Trim/Interior
Electrical Equipment	Tyres/Wheels
Overall Condition

Please advise any special features, competition history, restoration details (incl' costs) and current mileage:


	Mileometer Reading
Proposers estimated value £	Date:
	Signature:

This is to certify that the above vehicle is appraised as having a current value of £
taking into account the age and condition of the vehicle and the data/photographs supplied.

Signed	Date
On behalf of ATG Valuation Services

Check List - The following must be included to enable us to process your valuation
1. Fully Completed Form	2. Current Photographs	3. cheque payable to ATG Valuation Services for £12.50

I declare that the above information and particulars are true and complete to the best of my knowledge and belief. Furthermore I have not withheld any material fact and that the vehicle to be insured is and shall be kept in roadworthy condition and I agree that the proposal form, valuation Certificate and this declaration shall form the basis of the contract between the insurance company and myself as a policy holder.

This certificate is valid for insurance purposes only and is not to be construed as evidence of value for sale or purchase.