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Small Van and Commercial Vehicles & Fleets Quotation Request Form

fields marked with * are required   Proposer Details   Proposer Name *   Telephone *   Fax *   Email *   Contact Address & Post Code *   Nature of Business   Type of goods to be carried in vehicle/s   Overnight Parking Post Code   Nos of Years Trading   Nos of Years Experience in Trade     Policy Details   Date of Cover required from   Current Insurer   Type of Cover   Please Select Comp TPFT TPO Nos of Years No claims discount   No Claims discount Protection   Yes No Current Premium £   Current Policy Excess £     Drivers   Drivers   Please Select Insured Only Named Any Driver Over n/a 18-21 22-28 29-35 35-50 50- (only if applicable) Main Driver’s Name   DOB   Type of Licence   Test Passed Date   Occupation   Date of UK Residence   Class of Use Required (SDP is automatically included) Commuting to & from Work, Own Goods, In connection with Employers Business, Haulage, Hire & Reward (private/public), self drive Hire, Stage Fare, Other   Other Drivers (Provide same details as for main driver))     Convictions & Claims   Do you have any Convictions (incl pending) in the last five years   Yes No ( if YES - give details ) Have any claims been made in the past five years   Yes No ( if YES - give details )       Prime Vehicle Details   Make / Model *   Reg Number   Value   Year of Make   Engine size / cc *   Gross Vehicle Weight (In Tons)   Any Modifications (ie Refrigerated or attachments ie cranes)   Any Security Device fitted   Yes No Cover for more Vehicles required   Yes No       Additional Information Required for Fleet Quotations   Please state total number of vehicles in fleet and whether the combined value of the vehicles exceeds £250,000   Total number of vechiles. Yes No Advise details of any hazardous goods ie of an explosive, corrosive or dangerous nature are carried in the vehicles   Main Driver name * Please give details of ‘risk management systems’ in place – ie drivers being personally responsible of policy excess etc     It will be assumed that ALL drivers licences are checked at Inception of Employment and rechecked on an Annual basis.   For convenience please email or fax or post us a copy of schedule showing vehicle/cover details. Alternatively you can go through information by speaking to one of advisers during opening hours Mon-Fri 9.30 to 5.30 (Weds close – 4.30pm)   To request further information please contact us Click here for our instant online quotes for residential let property Click here for our instant online quotes for unoccupied / vacant property (Services available to UK residents and businesses only) (Authorised and regulated by the Financial Conduct Authority (FCA)) +44 (0)20 8574 7796 Email Us +44 (0)20 8813 8425