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Proposer Details
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Your Name
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Your Address 1
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Your Address 2
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Your Address 3
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Your Address 4
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Post Code
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Your Telephone
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Your Email Address
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Your Date of Birth
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Your Occupation
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Type of Cover Required
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Number of Years
No Claim Bonus
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Have you had any Accidents?
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If Yes – Please give details
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Have you had any Convictions?
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If Yes – Please give details
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When do you want Insurance Cover to
start?
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Best Quote so Far
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Additional Driver Name
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Date of Birth
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Occupation
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Have they had any Accidents?
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If Yes – Please give details
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Have they had any Convictions?
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give details |
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Vehicle Details |
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Vehicle Make
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Vehicle Model
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Engine Size
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| Value of vehicle |
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| Vehicle kept
overnight, garage? road?driveway?. |
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GVW: Gross Vehicle Weight?
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Year of Registration:
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IMPORTANT - In order to save
you time, please confirm that the following assumptions are
correct –
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The vehicle…
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has been registered and is kept by
you
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is not Q registered or modified in
any way
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is kept at your home address
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will not be used airside of any
airport/airfield
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will not be used to carry any
hazardous or toxic goods
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You, the proposer, and any
additional drivers:
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have held a full UK driving licence
for at least two full years
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have been permanently resident for 3
years
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have not been refused or declined
any type of insurance
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have not had a policy cancelled or
had special terms imposed by an insurer
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do not have ANY criminal convictions
(driving convictions can be accommodated subject to full
details being advised in the quotation questions)
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use the vehicle for social, domestic and pleasure and
commuting between home and permanent place of work. (carriage
of OWN goods - NOT haulage, hire and reward or self drive
hire) |
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free from any disability or infirmity (if any doubt exists as
to what constitutes a notifiable condition, you should
disclose it) |
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currently reside in England,
Scotland or Wales ONLY.
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If you have ticked YES to both you
qualify for our
Call us for confirmation.
If you have not, don’t worry, we have access to some of the
best rates and will be able to quote you a competitive price
Call Us 0845 241 0901
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