Tel: 08453 455 855

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Commercial Vehicle Insurance Quotation Form

For UK Customers Only

Please insert your details here and one of our commercial vehicle insurance advisers will contact you with a quotation shortly.

Commercial vehicle insurance meets the demands and needs of individuals or companies wishing to insure their commercial vehicle(s) for use on the road in connection with their business. Due to the high frequency of premium rate changes, please only leave your details if your renewal date or start date is within the next 30 days.

If you have any problems with completing this form, please phone us on 08453 455 855 for assistance.

Proposers/Company Details

Who is the registered owner of the vehicle? (if not the proposer)
If vehicle is registered in a company name, please state the name of your company:-
Business / Trade: (e.g. plumber, builder, etc.)
Please state the purpose of use for the vehicle: (e.g. collection of goods from wholesaler, carry tools & materials, etc.)
Business Address:
Business Postcode:
Daytime Telephone No.
E-Mail Address:
Date Cover Required:	(dd/mm/yyyy)

Proposers / Main Drivers Details

Status:
First Name:
Surname:
Occupation:
Employment Status: (if not self employed)
Date of Birth:	(dd/mm/yyyy)
Marital Status:
How long have you lived in the U.K. (years):
Type of Licence:
Number of years licence held:
Do you also own a car?
If yes, please state number of years No Claims Discount on the car policy:

Vehicle Details

Type/Category of Vehicle: (if other than a van)
Vehicle Make (i.e. Ford, Leyland Daf, etc.):
Vehicle Model (i.e. Transit, Convoy, etc.):
Vehicle Type (i.e. TDI, 190, 400, etc.):
Gross Vehicle Weight (kg):
Carrying Capacity (kg):
Vehicle Engine Size (c.c.):
Registration Number (if available):
Year Made:
Value of the Vehicle (£'s):
Additional Details
Fuel Type:
Postcode where vehicle is kept overnight: (if different from the business address)
Where is vehicle kept overnight:
Annual mileage driven in the vehicle:
Number of seats in the vehicle:
Is the vehicle left hand drive or imported?
Is the vehicle modified?
If yes, please provide details:
Type of Goods Carried: (if other than non-hazardous goods)
Details of use of the vehicle: (if other than Carriage of Own Goods)
Articulated Vehicles Only
Is a trailer/container attached to the vehicle:	No Yes
If yes, please state the value (£'s):

Cover & Driving Details
Cover
Type of cover required: (if other than comprehensive)
Total excess amount: (lower premiums for a higher excess)
Number of years No Claims Bonus:
Type of policy No Claims Bonus earned under: (if not under a commercial vehicle policy)
Is Protected No Claims Bonus required? (only available if you have at least 4 years No Claims Bonus)	No Yes
Driving Details
Who will drive the vehicle?
Have you or any other driver who will drive the vehicle had any accidents or claims in the last five years?
If yes, please provide details:	Name of Driver: Date of claim: Whether at fault: Claim type(theft, accident, etc.): Cost of claim:� ----- Name of Driver: Date of claim: Whether at fault: Claim type(theft, accident, etc.): Cost of claim:� ----- Name of Driver: Date of claim: Whether at fault: Claim type(theft, accident, etc.): Cost of claim:� ----- Unfortunately, we are unable to provide a quotation if you are exceeding 3 claims. -----
Have you or any other driver who will drive the the vehicle been convicted of any motor offence?
If yes, please provide details:	Name of driver: Date of conviction: Type of conviction: No. of points: Amount of fine:� Was there a driving ban: If yes, length of ban: ----- Name of driver: Date of conviction: Type of conviction: No. of points: Amount of fine:� Was there a driving ban: If yes, length of ban: ----- Name of driver: Date of conviction: Type of conviction: No. of points: Amount of fine:� Was there a driving ban: If yes, length of ban: ----- Unfortunately, we are unable to provide quotations for more than 3 driving convictions. -----
Does you or any other driver who will drive the vehicle have any disabilities?
If yes, please provide details:	Name of driver: Type of disability: Whether D.V.L.A. informed: If yes, when declared to the D.V.L.A.: Licence restriction: ----- Name of driver: Type of disability: Whether D.V.L.A. informed: If yes, when declared to the D.V.L.A.: Licence restriction: ----- Name of driver: Type of disability: Whether D.V.L.A. informed: If yes, when declared to the D.V.L.A.: Licence restriction: -----

Details of Driver 2 (if applicable)

Status:
First Name:
Surname:
Their Primary Occupation:
Their Employers Business:
Employment Status:
Date of Birth:
Marital status:
How long have they lived in the U.K. (years):
Type of licence:
How long have they held their licence? (years):
Relationship to Proposer:

Details of Driver 3 (if applicable)

Status:
First Name:
Surname:
Their Primary Occupation:
Their Employers Business:
Employment Status:
Date of Birth:
Marital status:
How long have they lived in the U.K. (years):
Type of licence:
How long have they held their licence? (years):
Relationship to Proposer:

Request Quotation

Disclosure
Please ensure that all the information you have provided is correct and that you have answered all the questions accurately then press the Request Insurance Quotation button to send your quotation details to us.