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Motor Insurances

We have extensive facilities for:

  • Private Motor  ***
  • Commercial Motor ***
  • Motor Fleet
  • Classic Cars
  • Taxi
  • Drivers with claims convictions
  •  


1. Personal Details
Title:
First Name
Surname
Date of Birth
E-Mail Address
Phone Number
County
Gender Male Female
Occupation
Are you employed
Are you Self employed
Type of licence here
Have you ever been convicted of any motoring offence? Yes No
if Yes please give details.
Do you have penalty points if yes how many
2. Vechicle Details
Vehicle Make
Model
Registration number
Licence Type
Do you have a No Claims Bonus Yes No
If Yes how many years
Cubic Capacity (cc)
Year of Manufacture
Present Estimated Value
Annual Mileage
Have you ever been convicted of any motoring offence? Yes No
if Yes please give details.
Have you ever been involved in any accident or theft in the last 5 years? Yes No
If Yes please give details.
Details of any physical or mental disabilities or infirmities.
This text box is for any other details you may feel relevant.
Tick this box to add an additional Driver
Commercial Motor  
Is there signage on the vehicle Yes No
Area of use
Area kept overnight
Are you employed ? Yes No
Self employed Yes No
Type of goods carried
No of seats
Carrying capacity
Vat registered Yes No
Claims history
Have you ever been involved in any accident or theft in the last 5 years? Yes No
If Yes please give details
Do you have a No Claims Bonus Yes No
If Yes how many years
Current insurer
Renewal date
Have you current named driver accident free experience
If so how many years
Named on whose policy
Name of insurer
COVER required
Details of any physical or mental disabilities or infirmities.
Other details
   
 
3. Additional Driver Details
Main Driver Name
All of the following fields refer to the additional Driver
Title
Surname
First Name
Telephone
Gender Male Female
Date of Birth
Occupation
Licence Type
Do you have any penalty points Yes No
If Yes(How many)
Does the additional driver have full time use of another vehicle. Yes No
Have you (additional driver) ever been convicted of any motoring offence if "Yes" please give details. Yes No
Details of motoring offence
Have you (additional driver) ever been involved in any accident, loss or theft in the last 5 years. If "yes" please give details. Yes No
Details of accident, loss or theft
Details of any physical or mental disabilities or infirmities.
Do you have other insurances? if so please advise as we may be able to get additional discounts Yes No
If yes please give details
Please submit this form before returning to main motor form page
This form is for quotation purposes only and is not confirmation of a quote or insurance cover. Insurance cover will only commence on receipt of a completed proposal form, payment and written confirmation from ourselves.
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