Policy Holder Details

Title:	Mr Mrs Miss Ms Dr *
Surname:	*
First Name:	*
House number/name where vehicle kept overnight:	*
Postcode where vehicle kept overnight:	*
Contact No:	*
Email address:

Please complete all fields marked with * to proceed.

 Vehicle Details

Registration of vehicle (if known):
Make of vehicle (Ford, Vauxhall etc):	*
Model of vehicle (Escort Ghia 16v etc):	*
Engine Size:
Fuel Type:	- Petrol Diesel LPG Electric
Year of vehicle:	*
Value of vehicle:
Where is the vehicle kept overnight?	- Drive Garage Public road Locked compound Car Park
How many miles per annum will you travel in the vehicle?

Please complete all fields marked with * to proceed.

   

 Insurance Cover

What cover do you require?	Comprehensive Third Party Fire Theft Third Party Only *
Who is to drive the car?	Insured Only Insured & spouse Insured & common law spouse Insured & civil partner Insured & 1 named driver Insured & 2 named drivers Insured & 3 named drivers Insured & 4 named drivers Any driver Any driver over 25 Any driver over 30 *
What would the vehicle be used for? *	Social domestic pleasure & commuting Social domestic & pleasure only Class 1 business use for pre arranged appointments Class 2 business use for non pre arranged appointments Hire & Reward
If Business Use required, please   advise who will be using the vehicle   for business use:	No Business Use Proposer Driver 1 Driver 2 Driver 3 *
How many years no claims bonus do you have to use on this vehicle?	0 1 2 3 4 5 6+ *
If you have 4+ years no claims bonus, would you like it protected?	No Yes *

Please complete all fields marked with * to proceed.

 

 Driver Details

Policyholder date of birth:	*
Marital status:	Single Married Common Law Divorced Widowed *
What type of driving licence do you have?	Full U.K Provisional EEC (EU) Foreign International 4 years *
How long have you had the licence for?	5yrs+ Less than 1 year 1 year 2 years 3 years 4 years *
How long have you lived in the UK for?	Life Less than 1 year 1 year 2 years 3 years 4 years 5yrs+ *
What extent are you using the vehicle?	Main Casual Frequent *
Will you use the vehicle for commuting?	Yes No *
Full time occupation:	*
Employment status i.e. employed, self employed:	*

Please complete all fields marked with * to proceed.

 Final Step

To proceed and obtain a quote please check the agreement box, then click the "Quote Me Please" button below:

Please tick this box to confirm you authorise us to contact you regarding this quotation.