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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 / Trading As:
(if different to the above) | |
| Trading Status: | |
| Occupation/Trade: | |
| Business Address: | |
| Postcode: | |
| Do you have a different correspondence address? | Yes No |
| Correspondence Address: | |
| Correspondence Postcode: | |
| Daytime Telephone Number: | |
| Mobile 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. |
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| Proposer's Details |
Have you, or any other partner or director
ever been convicted of or charged (but not yet tried)
with any criminal offences other than a motoring offence? | Yes No |
If yes, please provide details:
(e.g. type of conviction(s),
date(s) of conviction(s),
details of any fines and/or length of custodial sentence(s)) | |
Has any insurer ever refused renewal, declined/
cancelled cover or imposed any special terms? | Yes No |
If yes, please provide details:
(e.g. details of any insurance refused/
cancelled/special terms imposed, etc.) | |
Have you, or any other partner or director
ever been declared bankrupt or insolvent
or been subject to any County Court Judgements? | Yes No |
If yes, please provide details:
(e.g. date(s) of bankruptcy/insolvency,
amount of bankruptcy/insolvency,
date bankruptcy discharged or CCJ/IVA settled,
circumstances, etc.) |
Please note we are unable to provide a quote if your bankruptcy
is not discharged or your CCJ / IVA remains outstanding or unsettled. |
Have you, or any other partner or director
ever been prosecuted or served a prohibition
order by the Health & Safety Executive? | Yes No |
If yes, please provide details:
(e.g. date of prosecution(s),
details of offence(s), etc.) | |
| Business Activities |
| Description of work undertaken (Must add up to 100%): |
| Accessory Fitting - New | % |
| Tow Bar Fitting | % |
| Auto Electrician | % |
| Crash / Body Repairs | % |
| Exhaust Fitter | % |
| LPG Conversions | % |
| Mechanical Repairs / Servicing | % |
| MOT Tester | % |
| Recovery | % |
| Smart Repairs | % |
| Tyre Fitter | % |
| Valeting | % |
| Vehicle Sales | % |
| Other (Please specify) : | % |
| | 100% |
| Type of vehicles worked on (Must add up to 100%): |
| Cars and Light Commercial | % |
| Classic / Vintage Vehicles | % |
| Commercial Vehicles 3.5 tons to 7.5 tons | % |
| Commercial Vehicles 7.5 tons to 44 tons | % |
| Kit Cars | % |
| Left-Hand Drive | % |
| Minibuses up to 15 seats | % |
| Modified Vehicles | % |
| Motorcycles | % |
| Plant & Agricultural Vehicles | % |
| Sports & High Performance Vehicles | % |
| Trailers / Caravans | % |
| USA / Canadian Vehicles | % |
| Other (Please specify) : | % |
| | 100% |
| Trade Premises |
| Where do you trade from? | % - Home |
| | % - Business Premises |
| | % - Mobile |
| | 100% |
If you carry out any
Mobile work, is any of this work by the roadside? | Yes No |
| If yes, percentage of work by the roadside: | |
| Trade Questions |
Are you or your business involved in vehicle
salvaging, dismantling (even for spare parts),
breaking, scrap, sale of parts or recovery for such purposes? | Yes No |
Are you or your business involved
in selling, repairing or restoring
scooters, motorcycles, quad bikes or trikes? | Yes No |
Are you or your business involved
in the importing or exporting of vehicles? | Yes No |
|
| Do you or your business specialise in selling, repairing, servicing or restoring the following: |
| i. Sports or high performance cars? | Yes No |
| ii. Veteran, vintage or classic cars? | Yes No |
iii. Vehicles other than motor cars
or light commercial vehicles including
agricultural, horseboxes, HGV's, etc? | Yes No |
| iv. Grey imports? | Yes No |
Is the motor trade activity you carry out,
yours, and any directors or partners
full time self employed occupation? | Yes No |
If no, please provide details
of your other occupation / work: | |
| Heat Use / Paint Spraying |
| Do your activities involve the use of heat? | Yes No  |
If yes, please state the type of heat used:
(e.g. welder, blow lamp, grinder, etc.) | |
| Percentage of turnover from heat work: | % - On your premises |
| | % - Away from your premises |
Is any paint spraying carried
out away from your base premises: | Yes No |
| Hazardous Activities / Processes |
Do you work with any hazardous substances?
(e.g. radioactive substances, toxic/hazardous waste, etc.) | Yes No |
Do any of your processes
involve noise levels in excess of 85db? | Yes No |
| Trading Experience |
| How many years has your business been trading? | year(s) |
| Number of years experience (if different to years trading) | year(s)
|
| Claims Experience |
Have you or any other partner or director suffered
any loss or had any claims made against you in
the last 5 years whether insured or not? | Yes No |
| If yes, please provide details: | |
