Name
Company Name
Address
Postcode
Email
Mobile
Business_Status
Sole Trader
Partnership
Limited Company
Plc
Tiime In Business
New Start
One Year
Two Years
Three Years
Four Years
Five Years
Six Years
Seven Years
Eight Years
Nine Years
Ten Years+
Experience in Trade
New Start
One Year
Two Years
Three Years
Four Years
Five Years +
Based from Home
Yes
No
Business Description
Will your vehicles be used for any of the following occupations?
Please select
No
Carriage of passengers for hire or reward
Courier or parcel delivery
General scrap or metal dealers
Haulage
Landscape gardeners
Market traders
Motor traders
Plant hire operators
Roofers
Sand and ballast deliveries
Scaffolders
Skip hire
Tarmacers
Timber merchants
Waste disposal contractors
Cover Type
Third Party Fire and Theft
Comprehensive
Vehicle Use
Carriage Own Goods
Hire and Reward
Commercial Travelling
Social Domestic Pleasure Only
SDP and Commuting
Number of Drivers
Any driver over 25
Insured only
Insured and one named driver
Driver Details
Driver
Status
Age
Licence Type
Years Held
UK Resident
Married
Single
Divorced
Partnered
Widow
Divorced
Separated
Full UK
Provisional UK
International
EU Licence
Married
Single
Divorced
Partnered
Widow
Divorced
Separated
Full UK
Provisional UK
International
EU Licence
Married
Single
Divorced
Partnered
Widow
Divorced
Separated
Full UK
Provisional UK
International
EU Licence
Married
Single
Divorced
Partnered
Widow
Divorced
Separated
Full UK
Provisional UK
International
EU Licence
Married
Single
Divorced
Partnered
Widow
Divorced
Separated
Full UK
Provisional UK
International
EU Licence
Vehicle Information
Vehicle Make/Model
Weight KG
Value
Registration
Seats
NCD
Years
Security
Postcode
Overnight
Overnight
Nil
1
2
3
4
5
5+
None
Immobiliser
Alarm
Garage
Compound
Drive
Road
Car Park
Nil
1
2
3
4
5
5+
None
Immobiliser
Alarm
Garage
Compound
Drive
Road
Car Park
Nil
1
2
3
4
5
5+
None
Immobiliser
Alarm
Garage
Compound
Drive
Road
Car Park
Nil
1
2
3
4
5
5+
None
Immobiliser
Alarm
Garage
Compound
Drive
Road
Car Park
Nil
1
2
3
4
5
5+
None
Immobiliser
Alarm
Garage
Compound
Drive
Road
Car Park
Deep Fat Frying Facilities
-Choose-
No
Yes
Value of additional equipment
Is any vehicle one of the following?
None
Cement Mixers
Crew Cab
Foreign registered vehicles
Hi-Ab Cranes
Home/Kit built and Customised Vehicles
Horseboxes or livestock transporters
Minibuses
Q-Plated vehicles
Refrigerated vehicles
Skip Carriers
Tankers
Tippers
Vehicle Transporters
Vehicles over 7.5 tons
Vehicles with 4 or more seats
Waste disposal vehicles
Details of any vehicle Modification
Have you or any driver had any accidents, claims or losses?
Yes
No
Please provide full details
Any Convictions?
Yes
No
Please provide full details
Any Disabilities?
Yes
No
Please provide full details
Current Insurer
Renewal Premium