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Fleet Insurance Quotes
 
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Fleet Insurance Quote Form

For UK Customers Only

Please insert your details below and one of our commercial advisers will contact you shortly with a fleet insurance quotation. This form is designed for quotes for Fleet Insurance for a minimum of 5 vehicles only.

If you have any problems with completing this form, please phone us on 01623 641 386 for assistance.

Please note that in order to be eligible for a fleet quotation, all vehicles must be owned or leased by one body (i.e. a limited company, or individual).


Personal/Company Details

Proposer's Full Name(s):
(enter sole trader's name or all partner's names if a partnership)
Contact Name:
(if different to proposer's name)
Limited Company Name:
(if operating as a limited company)
Trading Name:
(if different to the above)
Trading Status:
Business Description / Activities:
Business Address:
Business Postcode:
Daytime Telephone Number:
E-Mail Address:
*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.
General Information

General Details
Have you, or any other partner or director
ever been convicted or charged (but not
yet tried) with any criminal offences?
Yes     No
If yes, please provide details:
(e.g. type of offence(s)
length of custodial sentence,
date of offence(s) etc.)
Have you, or any other partner or director ever been declared bankrupt/insolvent or subject to any County Court Judgements (CCJ's)/Sheriff Decrees or IVA's?Yes     No
If yes, please provide details:
(e.g. amount(s) of bankruptcy/insolvency/CCJ's,
date of bankruptcy/insolvency/CCJ's
date bankruptcy/insolvency/CCJ discharged or settled, etc.)
Have you, or any other partner or director
ever had any previous insurance refused/declined,
cancelled, renewal refused or had any special terms imposed?
Yes     No
If yes, please provide details:
(e.g. reason for refusal/declinature
details of any special terms imposed, etc.)
Have you been a director or officer of a company that has been declared insolvent, or had a receiver or liquidator appointed, or entered into arrangements with creditors in accordance with the Insolvency Act 1986?Yes     No
If yes, please provide details:
(e.g. name of director / officer,
name of previous insolvent company
amount(s) of insolvency,
date of insolvency,
amount of any outstanding debts, etc.)
Have you ever been
disqualified from being a company director?
Yes     No
If yes, please provide details:
(e.g. name of director,
reason for disqualification,
name of previous company,
date disqualified, etc.)
Have you ever been prosecuted under any Health & Safety or Environmental Protection legislation, or been served a Prohibition or Improvement Order under Health & Safety legislation?Yes     No
If yes, please provide details:
(e.g. date of prosecution / prohibition order,
reason for prosecution / prohibition order,
details of improvement made to avoid re-occurrence, etc.)

HMRC / Inland Revenue Investigations
Has the business ever been subject to an investigation or recovery action by HM
Revenue and Customs or the Inland Revenue?
Yes     No
If yes, please provide details:

Vehicle Ownership
Are all vehicles to be covered
owned by, or hired / leased to the proposer?
Yes     No
If no, please provide details:
Are any of the vehicles to be
insured personally owned by any directors?
Yes     No
If yes, please provide details:
(e.g. Make/Model of Vehicle(s) and
Registration Number(s) of Vehicle(s))

Dangerous Goods / Locations
Do any of the vehicles carry any
dangerous goods or substances, as defined
by the Carriage of Dangerous Goods regulations?
Yes     No
If yes, please provide details:
(e.g. details of dangerous substances carried,
volume or quantity of the dangerous substance carried,
Registration Number(s) of vehicle(s) carrying the substances)
Will any of the vehicles visit any hazardous locations?
(such as (but not limited to) power stations, dockside, nuclear installations, refineries or bulk storage or production premises in the oil, gas or chemical industries, Ministry of Defence premises, military bases, airside at any airport, rail trackside or other rail property, etc.)
Yes     No
If yes, please provide details:
(e.g. type of hazardous location(s),
Registration Number(s) of vehicle(s) visiting the locations)

Driving Licences
Do all drivers hold valid licences required by law
to drive the vehicles to which they are assigned?
Yes     No
If no, please provide details:

Operators Licence
Do you hold an Operator's Licence?Yes     No help
If yes, type of Operator's Licence held:
Operator Licence Postcode:

Non-Motoring Convictions
Has any person who, to your knowledge will drive under this insurance, ever been convicted for any criminal offence unless spent under the rehabilitation of offenders act?Yes     No
If yes, please provide details:
(i.e. name of driver(s),
date of conviction(s),
type / details of conviction,
was there a custodial sentence,
amount of any fine(s) (if applicable))

Trading Experience Details

Trading Experience
How many years has your business been trading? year(s)

Cover Required

Insurance Details
Cover required: Comprehensive
Third Party Fire & Theft
Third Party Only

Use required:
(Please tick all those applicable)
Social, Domestic & Pleasure ex. Commuting
Social, Domestic & Pleasure inc. Commuting
Business Use
Carriage of Own Goods
Haulage
Self-Drive Hire
Public Hire
Private Hire
Other (please describe below):

Do you require cover
for driving outside of the UK?
Yes     No help
If yes, please state type of territories and the
frequency of work spent at the location(s):

Driving Details

Drivers
Please confirm the driving restriction required: Any Driver (regardless of age)
Any Driver Over 21
Any Driver Over 25
Named Drivers

Drivers Claims (within last 3 years)
Have you or any other driver who will drive the
vehicles had any accidents or claims in the last three years?
Yes     No
If yes, please provide details:

Driving Convictions (within last 5 years and/or ALL Convictions involving a ban)
Have you or any other driver who will drive the
vehicles been convicted of any motor offence within
the last 5 years and ALL convictions involving a ban?
Yes     No
If yes, please provide details:

Medical Conditions
Do you or any other driver who will drive
the vehicles have any medical conditions or disabilities?
Yes     No
If yes, please provide details:

Drivers Under 25, Over 65, or With Less Than 2 Years Full UK Licence
Do you have any drivers aged under 25,
or over 65, or with less than 2 years full UK licence?
Yes     No
Details of Driver
Status:
First Name:
Surname:
Their Primary Occupation:
Their Employers Business:
Employment status:
Date of birth: (dd/mm/yyyy)
Driving status:
Marital status:
How long have they lived in the UK:
Type of licence:
How long have they held their licence? years
Relationship to Proposer:
Do you have any other drivers aged under 25,
or over 65, or with less than 2 years full UK licence?
Yes     No
Details of Driver 2
Status:
First Name:
Surname:
Their Primary Occupation:
Their Employers Business:
Employment status:
Date of birth: (dd/mm/yyyy)
Driving status:
Marital status:
How long have they lived in the UK:
Type of licence:
How long have they held their licence? years
Relationship to Proposer:

Fleet Vehicles to be Insured

Number / Type of Vehicles In Fleet
Number of vehicles in the fleet:
Types of vehicles in fleet:
(Please tick all those applicable)
Cars
Vans up to 3,500 Kg Gross Vehicle Weight (GVW)
Lorries up to 7,500 Kg Gross Vehicle Weight (GVW)
Lorries over 7,500 Kg Gross Vehicle Weight (GVW)
Minibus/Coaches

Details of Vehicles to be Insured

No.Make/ModelEngine
Size or
G.V.W.
YearValueNo. of
Years No
Claims Bonus
(if not previously
fleet rated)
Registration
Number
Overnight
Parked
Postcode
(if different to
business postcode)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.


Upload Fleet Schedule of Vehicles (optional)

Alternatively, if you wish to upload your fleet vehicle spreadsheet / schedule, or have more than 10 vehicles, press the button below to upload a spreadsheet / schedule of vehicles:


Please continue to complete the remainder of this form.

Modifications
Have any of the above vehicles been modified?Yes     No
If yes, please provide details:
(i.e. Registration Number(s) of modified vehicle(s)
and details of modifications)

Trailers
Do you require cover for trailers?Yes     No
If yes, please confirm the number of
trailers owned, hired, leased or lent to you?
If yes, is trailer cover required:Only whilst attached to a vehicle
Whilst attached or detached

Temporary Drivers / Risk Management

Temporary / Casual Drivers
Are Temporary / Casual / Agency Drivers employed?Yes     No
If yes, what is the maximum number of Temporary /
Casual / Agency Drivers employed at any one time?

Risk Management
Are any of the following risk management features in place?
(discounts may be available if you carry out any of the following)
1. All drivers are supplied with Driver Handbooks?Yes     No
2. Drivers supplied with details of what to do following an accident?Yes     No
3. New drivers are vetted for previous motor accidents
driving convictions and have their driving licence checked?
Yes     No
4. Existing drivers have their driving licences checked at least annually?Yes     No
5. All new drivers undergo an assessment of their driving ability?Yes     No
6. Procedures are in place for driving incident reporting and investigation?Yes     No
7. Procedures are in place for recording and carrying out analysis of driving incidents?Yes     No
8. Driver Training - Goods Carrying Vehicles - S.A.F.E.D.Yes     No

Cover Start Date / Renewal Date

Cover Start Date or Renewal Date: (dd/mm/yyyy)
Current Annual Premium / Best Quotation (£'s):
This may help us to get you a better quote
Name of Current/Previous Insurer:
(e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.)

Upload Claims Experience / History

Upload 3 Years Confirmed Claims Experience

In order for us to provide you with a quotation, please press the button below to
upload your last 3 years fleet Confirmed Claims Experience (CCE) form below:



Please note that regrettably we are unable to provide a fleet quotation without a 3 years Confirmed Claims Experience (CCE) form from your current/previous insurer's fleet policy and if not uploaded, you will have to contact them to obtain this document.

If you've not previously had a fleet policy and previously insured the vehicles individually, our insurers require a minimum of 1 year's No Claims Bonus on each vehicle before they are able to provide a fleet quotation.

Please continue to complete the remainder of this form.


Additional Information / Material Facts

Additional Information / Material Facts
Details of any additional information or material facts
that may affect the rating or acceptance of this insurance:
Under the legal principle of Utmost Good Faith, you are required to disclose all material facts which could affect acceptance of this insurance quotation. Failure to disclose a material fact could invalidate any future claims. By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.

Request Quotation

Disclosure
Please ensure that all the information you have provided is correct, then press the 'Request Fleet Insurance Quote' button below and we will contact you shortly with a quotation.


Estimated Quote Time: 1 to 4 working days