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 Ltd. company)
Trading name:(if different to the above)
Trading Status:
- - - - - Please Select - - - - -
Sole Trader
Partnership
Limited Company
Ltd. Liability Partnership (LLP)
Business Address:
Business Postcode:
Is the correspondence address different to the business address? Yes No
Correspondence address:
Correspondence 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.
Years Trading / Experience
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
21
22
23
24
25
26
27
28
29
30
30+
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
21
22
23
24
25
26
27
28
29
30
30+
years
General Information
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 or not, 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: per annum
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
Is 'Road Risks' cover required? Yes No
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 5 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.: c.c.
Year of Manufacture: (yyyy)
Value of Vehicle:
Registration Number:
Is the vehicle modified from standard specification? Yes No
Details of any Modifications:
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.: c.c.
Year of Manufacture: (yyyy)
Value of Vehicle:
Registration Number:
Is the vehicle modified from standard specification? Yes No
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 3rd vehicle below:-
Make (e.g. Ford, VW, etc.):
Model (e.g. Focus, Golf, etc.):
Type (e.g. LX, Club, etc.):
Engine Size c.c.: c.c.
Year of Manufacture: (yyyy)
Value of Vehicle:
Registration Number:
Is the vehicle modified from standard specification? Yes No
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 4th vehicle below:-
Make (e.g. Ford, VW, etc.):
Model (e.g. Focus, Golf, etc.):
Type (e.g. LX, Club, etc.):
Engine Size c.c.: c.c.
Year of Manufacture: (yyyy)
Value of Vehicle:
Registration Number:
Is the vehicle modified from standard specification? Yes No
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 5th vehicle below:-
Make (e.g. Ford, VW, etc.):
Model (e.g. Focus, Golf, etc.):
Type (e.g. LX, Club, etc.):
Engine Size c.c.: c.c.
Year of Manufacture:
Value of Vehicle:
Registration Number:
Is the vehicle modified from standard specification? Yes No
Details of any Modifications (if applicable):
Parked Postcode
Where is the vehicle parked overnight?
Road
Own Ground
Driveway
Garaged
Trade Plate(s) (if applicable)
Please list the registration numbers of any trade plates held (if applicable):
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
EU Provisional
EU Full
HGV Class 1
HGV Class 2
HGV Class 3
International
Number of years licence held: year(s)
Please advise if this driver has had any accidents or claims in the last 5 years (regardless of fault )? Yes No
If yes, please provide details:
Please advise if this driver has had any motoring convictions or offences in the last 5 years? Yes No
If yes, please provide details:
Please advise if this driver has any disabilities or medical conditions? 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 Employer's 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
EU Provisional
EU Full
HGV Class 1
HGV Class 2
HGV Class 3
International
How long have they held their licence? year(s)
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
Proposer's Employee
Proposer's 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 or medical conditions? 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 Employer's 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
EU Provisional
EU Full
HGV Class 1
HGV Class 2
HGV Class 3
International
How long have they held their licence? year(s)
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
Proposer's Employee
Proposer's 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 or medical conditions? Yes No
If yes, please provide details:
Public & Product Liability
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
Employers' Liability (Compulsory by Law if you have employees or apprentices)
Is Employers' Liability cover required? Yes No
Employers' Liability Limit of Indemnity:(£10 Million standard limit)
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:
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available) : (e.g. 123/AB12345 or 'Exempt')
Trade Premises Cover (for showrooms, workshops, yards, warehouses, car lots)
Is Trade Premises cover required?(i.e. for stock, contents, machinery/plant, tools, buildings, etc.) Yes No
Stock Vehicles
Is cover required for stock vehicles at your business premises? Yes No
If yes, please confirm the total value of stock vehicles at your premises:
Maximum number of stock vehicles at your premises:
Customer's Vehicles
Is cover required for customer's vehicles at your business premises? Yes No
If yes, please confirm the total value of customer's vehicles at your premises:
Maximum number of customer's vehicles at your premises:
Vehicles Kept Overnight at Premises
What percentage of vehicles kept on your premises overnight are:
(i) In locked premises/buildings: %
(ii) Inside a secured compound: %
(iii) Elsewhere in the open: %
Total: 100%
Please provide details of any other security precautions taken to protect the vehicles on your premises?(e.g. security guarding, perimeter fencing/gates, etc.)
Key Security
Where are all the keys to vehicles kept:
(i) During business hours:(e.g. key cabinet, safe, etc.)
(ii) Outside business hours:(e.g. home, business premises safe, etc.)
Premises Details / Occupancy
Are the premises in a good state of repair? Yes No
If no, please provide details:
Are you the sole occupant(s) of the business premises you occupy? Yes No
If no, please provide details of other occupants:
Is their portion self-contained with it's own lockable entrance/exit? Yes No
Are any parts of the premises unoccupied? Yes No
If yes, please provide details:(e.g. which floor is (part/fully) unoccupied, percentage of premises unoccupied, etc.)
Has the property ever suffered from subsidence or flood damage? Yes No
If yes, please provide details:(e.g. date of damage, amount of damage, type & circumstances of damage, etc.)
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? (yyyy)
Heating
Are the premises heated by fixed heating only? Yes No No Heating
Please confirm the type of fixed heating:
Electric
Gas
Oil
Other
If no, please provide details of portable heating:(e.g. No. of portable heaters, type of portable heaters (electric, gas, etc.), where used (workshop, office, etc.)
Fire Extinguishing Appliances
Do you have fire extinguishers to scale in the premises? Yes   No
Is there a fire alarm at the premises? Yes No
Type of fire alarm signalling:
Bells Only / Audible
Monitored - Central Station
Dialler - To Principals House
BT REDCARE - To Fire Brigade
Paint Spraying
Is paint spraying undertaken at the premises? Yes No
Percentage of turnover derived from paint spraying:(e.g. 10%) %
Is there a purpose built spray booth? Yes No
Is paint stored in metal cabinets / in a separate room? Yes No
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:
Audible - Bells or Siren
Digital Communicator to Central Station
Dual-Com to Central Station
Dialler - To Principals House Only
BT Redcare - To Police
BT Redcare GSM - To Police
Does the alarm incorporate confirmable technology? Yes No
Please provide details of any other security arrangements on the premises:(e.g. internal cctv, security lighting, grilles, shutters, etc.)
Health & Safety
Do you have a formal Health & Safety policy? Yes No
Name of person responsible for Health & Safety?
Are Risk Assessments carried out and recorded? Yes No
Do you have a formal safety training plan for employees? Yes No
Do you have a formal procedure for high risk activities? Yes No
Electrical Maintenance
Do the premises have a current IEE electrical certificate? Yes No
Claims Experience (All Sections of Cover Excluding Road Risks)
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, amount claimed, circumstances of claim, etc.)
Cover Type
Standard cover is for Fire, Theft and Special Perils.
Do you wish to extend your cover to include accidental damage for an additional premium? Yes No
Do you wish to extend your cover to include cover for terrorism for an additional premium? Yes No
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:
Office Contents excl. computers/diagnostic equipment:
Computers & Diagnostic Equipment:
Portable Hand Tools & Equipment:
Employees Own Tools (up to £2,500 per tool) :
Stock
General Stock Sum Insured:(excluding tyres and 'high risk' theft stock)
Stock of Tyres Sum Insured:
Other Stock incl. 'high risk' theft stock: Specify:(e.g. audio/tv, mobile phones, etc.)
External Glass & Signs
External Glass Sum Insured:
External Signs Sum Insured:
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) :(Please amend if greater cover is required)
A.T.M. Cash Machine
Is there an A.T.M. cash machine at the premises? Yes No
If yes, are you responsible for the cash? Yes No
If yes, max. amount of cash within the machine?
Wrongful Conversion
Is cover required for wrongful conversion?(Provides cover if you purchase a vehicle from someone who is not the true owner and the true owner subsequently makes a claim for the return of the vehicle or its cash value) Yes No
Estimated annual amount paid by you for second-hand vehicles including allowances made for part-exchange:
Limit of indemnity required:(e.g. £25,000)
Are you a subscriber to H.P.I. information Equifax Gold Checks, or any other? Yes No
Do you keep accurate records of all purchase transactions for second-hand vehicles? Yes No
Goods In Transit (own vehicles)
Goods in Transit sum insured (if required) :(stock and parts in transit)
Do you require Business Interruption cover? Yes No
If yes, please confirm your Annual Gross Profit: per annum
Please confirm the business interruption maximum indemnity period cover is required:
12 months
24 months
36 months
Is Business Legal Expenses cover required?(£100,000 legal defence costs for contract disputes, employment disputes, VAT investigations, etc.) Yes No
Has the business and/or its directors been involved in any legal dispute, tax investigation or any other court or tribunal action in the last 5 years? Yes No
Please provide details of the dispute including dates:
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:
You are required to make a fair presentation of the risk to insurers which means that you are required to disclose every material circumstance which you know or ought to know relating to the risk to be insured. Materially important information is any information that could influence an insurer's decision to accept your risk including the cost of your insurance. Failure to comply with the duty of fair presentation could mean that your policy is void or that insurers are not liable to pay all or part of your claim(s). By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.
Renewal date / date cover required: (dd/mm/yyyy)
Current annual premium: This may help us to get you a better quote
Name of current / previous insurer: e.g. Aviva, AXA, Allianz, NIG, Tradex, RSA, Zurich, etc.