Has the proposer or any person named on this policy been refused insurance or had a policy cancelled by an insurance company, or had any special terms imposed?
Has the proposer or any person named on this policy ever had a county court judgement against them?
Has the proposer, director or partner of the business or practice ever been declared bankrupt?
Has any proposer, director, partner of the business/practice or person named on this policy had any convictions, criminal offences or prosecutions pending other than motor offences?
NO
Title
Proposer (put 'business' in not an individual)
Contact Name
Date Of Birth (dd/mm/yyyy)
Business Name
Email
Contact Phone Number
Other Phone Number
Business Address
Number or Name
Street
Town or City
County
Postcode
Renewal / Start Date Required (dd/mm/yyyy)
Is the company LTD? Select Yes No
Company Trade
Your Occupation
Registration Number
Vehicle make and model
Vehicle Year
Vehicle Engine cc
Fuel Type Select Petrol Diesel LPG Other
Vehicle Type Select Car Taxi Mini Bus MPV Other
Annual Mileage
Number of seats
Vehicle Value (£)
Vehicle Security Select No Additional Security Factory Fitted Professionally Fitted Tracker
Overnight Parking Select Roadside Off Road / Driveway Locked Compound Locked Building
1st line of address where vehicle is kept overnight
Overnight post code
Type of driving licence Select Full UK Provisional EU International
Licence held for (years)
Is the vehicle sign written Select Yes No
Driver's Required Select Proposer Only Proposer + Spouse Proposer + 1 Named Proposer + 2 or More Any Driver 25 & Over Any Driver 21 & Over Any Driver
No. of previous claims (all drivers)
No. of previous convictions (all drivers)
Vehicle Usage Select Private Hire Contract Hire Chauffeur Education Charity Hackney Carriage
Cover Required Select Fully Comprehensive 3rd Party - Fire & Theft 3rd Party Only
Who is your Local Licencing Authority
How many other vehicles do you have access to
How many years no claims discount for this vehicle
Any special requirements (e.g. breakdown cover)
Protected No Claims required Select Yes No
Do you require liability cover Select £1,000,000 £2,000,000 £5,000,000 Not Required
Do you require Employer's Liabilty (£10m as standard) Select Yes No
Please inform us of anything else we should know.
Please tell us the best quote you have received so far and we will try and beat it
Policy Quote Amount (£)
We will be in contact regarding your insurance quote within 24 hours to confirm details and progress the policy.
