Proposers/Company Details
Proposers Name(s) (incl. all partners names if partnership ):
Limited Company Name (if applicable ):
Trading Name:
Trading Status:
- - - - Please Select - - - -
Sole Trader
Partnership
Ltd. Company
Ltd. Liability Partnership
Business Address:
Business Postcode:
Correspondence Address: (if different from above)
Daytime Telephone No.
E-Mail Address:
General Information
General Details
Please state the number of years trading in the motor trade:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
20+
years
If a new venture, please state the number of years previous experience in the motor trade (if applicable) :
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
20+
years
Have you, or any other partner or director ever been convicted of or charged with any criminal offence? Yes No
If yes, please provide details:(i.e. date of conviction, type of conviction, length of custodial sentence, etc.)
Have you, or any other partner or director had a CCJ registered against you or ever been declared bankrupt or insolvent? Yes No
If yes, please provide details:(i.e. date of bankruptcy/insolvency, amount of bankruptcy/insolvency, whether discharged, etc.)
Has any insurer ever refused, declined, cancelled or imposed any special terms in respect of your motor traders insurance? Yes No
If yes, please provide details:(i.e. name of insurer, reason for refusal/special terms, etc.)
Business Details
Buying / Selling / Wholesaling: %
Importing / Exporting: %
Mechanical / Servicing / Overhauls: %
Crash Body Repairs / Spraying: %
Vehicle Recovery / Deliveries / Breakdowns: %
Car Breaking / Sale of Second Hand Parts: %
Body Builders / Commercial Vehicle Repairs: %
Motor Accessories - Distribution / Fitting: %
Valeting / Steam Cleaning / Renovations: %
Other Activities (please specify) : %
Total: 100%
Approximate number of vehicles sold / repaired / handled in any one year?
Estimated annual turnover (£s):
Are you registered for VAT? Yes No
Maximum capacity (in vehicles):
Type of Premises Trading From
Please confirm the type of premises you trade from:
- - - - - Please Select - - - - -
Home Address
Yard Away From Home
Workshop
Warehouse
Open Car Lot
Shared Premises
Showroom
Mobile
Other
Road Risks
Vehicles To Be Covered
Private Cars: %
Sports or High Performance Vehicles: %
American / Canadian Vehicles: %
Vintage / Classic Cars: %
Light Commercial Vehicles up to 3.5 tonnes GVW: %
Vehicles over 3.5 tonnes Gross Vehicle Weight: %
Motorised Horse Boxes / Agricultural Vehicles: %
Coaches / Minibuses: %
Skip / Tipping Vehicles for Scrap Metal / Waste Collection: %
Breakdown trucks / Vehicles with Trailers / Recovery Vehicles: %
Rally / Track / Kit Cars / Quad Bikes: %
Imported Vehicles: %
Total: 100%
Cover Details
Full-time or part-time motor trader: Full-time Part-time
Please confirm the cover required:
- - - - Please Select - - - -
Comprehensive
Third Party Fire & Theft
Third Party Only
Please state the indemnity limit required per vehicle:
Please Select
£5,000
£7,500
£10,000
£12,500
£15,000
£20,000
£30,000
£40,000
£50,000
£60,000
£70,000
£80,000
£90,000
£100,000
£100,000+
Is windscreen cover required?(comprehensive policies only) Yes No
Is demonstration cover required? Yes No
Drivers:
Insured Only
Named Drivers
No. of years No Claims Bonus:
0
1
2
3
4
5
5+
years
Type of policy NCB earned under:
Motor Trade Policy
Private Car Policy
Commercial Vehicle Policy
Self Drive Hire Policy
N/A - No Bonus
Other
Own Vehicle Details (if applicable)
Do you wish to insure your own vehicle(s) on your motor traders policy?(maximum of 2 vehicles) Yes No
If yes, please provide details of your vehicle below:-
Make (e.g. Ford, VW, etc.):
Model (e.g. Focus, Golf, etc.):
Type (e.g. LX, Club, etc.):
Engine Size c.c.:
Year of Manufacture:
Value of Vehicle (£s):
Registration Number:
Details of any Modifications (if applicable):
Parked Postcode
Where is the vehicle parked overnight?
Road
Own Ground
Driveway
Garaged
Additional Own Vehicle (if applicable)
Do you wish to include another vehicle? Yes No
If yes, please provide details of your 2nd vehicle below:-
Make (e.g. Ford, VW, etc.):
Model (e.g. Focus, Golf, etc.):
Type (e.g. LX, Club, etc.):
Engine Size c.c.:
Year of Manufacture:
Value of Vehicle (£s):
Registration Number:
Details of any Modifications (if applicable):
Parked Postcode
Where is the vehicle parked overnight?
Road
Own Ground
Driveway
Garaged
Road Risks Cover - Main Driver Details
Status:
Mr
Miss
Mrs
Ms
Dr
First name:
Surname:
Occupation:
Employment status:
Co. Director
Employed
Other
Retired
Self-Employed
Unemployed
Other (part-time) occupation (if applicable) :
Date of birth: (dd/mm/yyyy)
Driving status:
Main Driver
Frequent
Casual
Non-Driving
Marital status:
- - - Please Select - - -
Common Law Married
Divorced
Married
Seperated
Single
Widowed
Number of years resident in the UK?
Since Birth
0 years
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
20+ years
Type of licence:
Please Select
Provisional UK
Full UK
EEC Provisional
EEC Full
HGV Class 1
HGV Class 2
HGV Class 3
International
Number of years licence held:
Please advise if there have been any accidents or claims in the last five years (regardless of fault )? Yes No
If yes, please provide details:
Please advise if there have been any motoring convictions or offences? Yes No
If yes, please provide details:
Please advise if there are any 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:
Employment status:
Co. Director
Employed
Other
Retired
Self-Employed
Unemployed
Date of birth: (dd/mm/yyyy)
Driving status:
Main Driver
Frequent
Casual
Non-Driving
Marital status:
Single
Married
Common Law Married
Divorced
Seperated
How long have they lived in the UK:
Since Birth
0 years
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
20+ years
Type of licence:
Full UK
Provisional UK
EEC Provisional
EEC Full
HGV Class 1
HGV Class 2
HGV Class 3
International
How long have they held their licence? years
Relationship to Proposer:
Brother or Sister
Business Partner
Common-Law Spouse
Daughter or Son
Daughter-In-Law/Son-In-Law
Director
Family
Lodger
Not Applicable
Parent
Partner - Civil
Proposers Employee
Proposers Employer
Sister-In-Law/Brother-In-Law
Spouse
Tenant
Unrelated
Has this driver had any accidents or claims in the last five years? (regardless of fault ) Yes No
If yes, please provide details:
Has this driver ever been convicted of any motor offence? Yes No
If yes, please provide details:
Does this driver have any disabilities? Yes No
If yes, please provide details:
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:
Employment status:
Co. Director
Employed
Other
Retired
Self-Employed
Unemployed
Date of birth: (dd/mm/yyyy)
Driving status:
Main Driver
Frequent
Casual
Non-Driving
Marital status:
Single
Married
Common Law Married
Divorced
Seperated
How long have they lived in the UK:
Since Birth
0 years
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
20+ years
Type of licence:
Full UK
Provisional UK
EEC Provisional
EEC Full
HGV Class 1
HGV Class 2
HGV Class 3
International
How long have they held their licence? years
Relationship to Proposer:
Brother or Sister
Business Partner
Common-Law Spouse
Daughter or Son
Daughter-In-Law/Son-In-Law
Director
Family
Lodger
Not Applicable
Parent
Partner - Civil
Proposers Employee
Proposers Employer
Sister-In-Law/Brother-In-Law
Spouse
Tenant
Unrelated
Has this driver had any accidents or claims in the last five years? (regardless of fault ) Yes No
If yes, please provide details:
Has this driver ever been convicted of any motor offence? Yes No
If yes, please provide details:
Does this driver have any disabilities? Yes No
If yes, please provide details:
Public/Employers Liability Cover
Is Public & Products Liability cover required? Yes No
Public / Product Liability Limit Of Indemnity:(£2 Million automatically included)
£2,000,000
£5,000,000
Is Sales and Service Indemnity required? Yes   No
Is Employers' Liability cover required? Yes No
Employers' Liability Limit of Indemnity:(£10 Million automatically included)
Please confirm the total number of manual employees:
Please confirm the total annual wages of manual employees:
Please confirm the total number of clerical employees:
Please confirm the total annual wages of clerical employees:
Business Premises
Trade Premises Cover (for showrooms, workshops, yards, warehouses, car lots)
Is trade premises cover required? Yes No
Stock Vehicles
Is cover required for stock vehicles at your business premises? Yes No
If yes, please confirm the total value of vehicles at the premises:
Number of vehicles at the premises:
Construction of Trade Premises
Construction of walls (e.g. brick, stone, etc.) :
Construction of roof (e.g. tile, slate, concrete, felt, etc.) :
Is there any flat roof? Yes No
If yes, please confirm percentage flat roof: %
Please confirm the type of flat roof(e.g. 'felt on timber' or 'concrete', etc.)
Construction of floor (e.g. concrete, wooden, etc.)
What year were the premises built?
Security
Are all your external doors fitted with a minimum of 5 lever mortise deadlocks (BS3621) or equivalent and all accessible windows and skylights fitted with key operated window locks? Yes No
Are your premises protected by an annually maintained intruder alarm? Yes No
If yes, is the alarm NACOSS/NSI approved? Yes No Not Sure
Type of intruder alarm signalling:
- - - - - - Please Select - - - - - -
Audible - Bells or Siren
Monitored - Central Station
Dialler - To Principals House
BT REDCARE - To Police
Please provide details of any other security arrangements:(e.g. own internal cctv, etc.)
Occupancy
Are you the sole occupant(s) of the business premises you occupy? Yes No
If no, please provide details of other occupants:
Claims Experience/History
Have you, or any other partner or director (in this or any other trading name) suffered any loss or had any claims made against you in the last 5 years? Yes No
If yes, please provide claim details:(i.e. date of claim, circumstances of claim, amount claimed, etc.)
Has the property ever suffered from subsidence or flood damage? Yes No
If yes, please provide details:(e.g. type of damage, date of damage, amount of damage, etc.)
Cover
Buildings (if required)
Buildings Sum Insured including outbuildings, rebuilding architects' fees, removal of debris, etc:
Do you require subsidence cover for your buildings? Yes No
Tenants Improvements (if required)
If you are a tenant, do you require cover for the improvements you have made to the property? N/A Yes No
If yes, please state the sum insured:
Contents
Fixed Plant & Equipment (£s) :
Office Contents excl. computers/diagnostic equipment (£s) :
Computers & Diagnostic Equipment (£s) :
Portable Hand Tools & Equipment (£s) :
Employees Own Tools (up to £2,500 per tool) :
Stock
General Stock Sum Insured (£s) :
Other Stock incl. 'high risk' theft stock (£s) : Specify:
External Glass / Signs
External Glass Sum Insured (£s) :
External Signs Sum Insured (£s) :
Money
Money during business hours / in transit to bank:(Please amend if greater cover is required)
Money outside business hours in locked safe:(Please amend if greater cover is required)
Money at the home of the Insured (if required) :
Business Interruption
Do you require Business Interruption cover? Yes No
If yes, please confirm your Annual Gross Profit (£s):
Additional Covers
If there is any other cover that you wish to include, or if you are aware of any information that could affect the acceptance of the risk, please provide details:
Details Of Current / Previous Policies
Current annual premium: This may help us to get you a better quote
Current/previous insurer:
Renewal date/date cover required: (dd/mm/yyyy)