Ownership Details
Please state who is the registered owner of the minibus:(if not the proposer)
Proposer
Spouse
Company Owned
Charity
Other
If registered in a company or a charity name, please state the name of your company/charity:
Proposer's Details
Status:
Mr
Miss
Mrs
Ms
Dr
First Name:
Surname:
Address:
Postcode:
Daytime Telephone No.
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.
Insurance Details
Renewal date / date cover required: (dd/mm/yyyy)
Name of current / previous insurer: (e.g. None, Aviva, ERS, QBE, etc.)
Current premium / best quote: This may help us to get you a better quote
NB. Proposer must be the main driver
Proposer's Occupation:
Employer's Business:
Employment Status:
- - - - Please Select - - - -
Employed
Company Director
Household Duties
Independent Means
Retired
Self Employed
Unemployed
Date of Birth: (dd/mm/yyyy)
Marital Status:
- - - - Please Select - - - -
Single
Married
Common Law Married
Seperated
Divorced
Widowed
How long have you lived in the UK? year(s)
Type of Licence:
- - - - Please Select - - - -
Full U.K.
Foreign
Provisional
P.S.V.
International
Number of years licence held: year(s)
Usage Required:
- - - - - - - - - - - Please Select - - - - - - - - - - - - -
Social,Domestic & Pleasure incl. to & from work
Social,Domestic & Pleasure excl. to & from work
Business Use
Private Hire
Public Hire
Voluntary Use
Charity Use
Please state the reason/details of use for the vehicle:(e.g. private family use, private hire, charity use, etc.)
Public/Private hire users only
If used for private/public hire, please confirm number of years established: year(s)
If used for private/public hire, is the minibus fitted with a 2 way radio? Yes No
Is the minibus plated? Yes No
Type of Vehicle:(re-type, if not a minibus)
Number of seats in the vehicle:(Including Drivers Seat)
Are all the seats forward facing? Yes No
Are seat belts fitted? Yes No
Value of the Vehicle (£'s) :
Vehicle Make (i.e. Ford, Leyland Daf, etc.) :
Vehicle Model (i.e. Transit, 400, etc.) :
Engine Size (c.c.) :
Fuel Type:
- - Please Select - -
Petrol
Diesel
Gas
Year of Manufacture:
Date of Purchase: (dd/mm/yyyy)
Registration Number (if available) :
Postcode where vehicle is kept overnight:(re-type, if different from the above address)
Where is vehicle kept overnight:
- - Please Select - -
Garage
Carport
Driveway
Locked Compound
Own Ground
Road
Annual mileage driven in the vehicle:
Is the minibus fitted with an immobiliser? Yes No
Has the vehicle been imported or is it left hand drive? Yes No
Has the vehicle been modified? Yes No
If yes, please provide details of the modifications:
Cover Required
Type of Cover:
- - - - - Please Select - - - - -
Comprehensive
Third Party, Fire & Theft
Third Party Only
Excess required:
£100
£150
£200
£250
£300
£350
£400
£500
£750
£1000
Is breakdown cover required?: Yes No
No Claims Bonus
Number of years No Claims Bonus:
0
1
2
3
4
5
6
7
8
9
9+
year(s)
If you hold No Claims Bonus, state the type of policy No Claims Bonus earnt on:
Commercial Vehicle
Minibus
Not Applicable
Other
Private Car
Is Protected No Claims Bonus required?(only available if you have at least 4 years no claims bonus)
- - - Please Select - - -
No
Yes
Not Applicable
Driving Details
Who will drive the vehicle?
- - - - - Please Select - - - - -
Proposer Only
Proposer & Named Drivers
Any Driver Over 25
Any Driver
Claims History
Have you or any other driver who will drive the vehicle had any accidents or claims in the last five years? Yes No
If yes, please provide details:
Driving Convictions
Have you or any other driver who will drive the vehicle been convicted of any motor offence? Yes No
If yes, please provide details:
Medical Conditions
Do you or any other driver who will drive the vehicle have any medical conditions or disabilities? Yes No
If yes, please provide details:
Additional Drivers
Do you wish to add another driver? Yes No
Details Of Driver 2
Status:
Mr
Miss
Mrs
Ms
Dr
First Name:
Surname:
Their Primary Occupation:
Their Employers Business:
Date of Birth:
Marital status:
Single
Married
Common Law Married
Divorced
Seperated
How long have they lived in the U.K.? year(s)
Type of licence:
Full U.K.
Foreign
Provisional
P.S.V.
International
How long have they held their licence? year(s)
Additional Drivers
Do you wish to add another driver? Yes No
Details Of Driver 3
Status:
Mr
Miss
Mrs
Ms
Dr
First Name:
Surname:
Their Primary Occupation:
Their Employers Business:
Date of Birth:
Marital status:
Single
Married
Common Law Married
Divorced
Seperated
How long have they lived in the U.K.? year(s)
Type of licence:
Full U.K.
Foreign
Provisional
P.S.V.
International
How long have they held their licence? year(s)