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Present Insurer:
Renewal Date:
Current Premium inc IPT:
Target Premium inc IPT:
Fleet Rated:
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Response Date:
Current Cover and Excess:
Required Cover and Excess:
Full Trading Name *
Please enter Proposers Registered Address including Postcode*
Please provide Proposers Operating Address including Postcode if different from above
Business / Occupation *
Operators License Held?
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Nature of Proposer's business and purpose for which vehicles are used:
Are passengers carried for hire or reward?
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Yes No
If Yes, please indicate the nature of your operations and % of turnover
Private Hire / Contract Hire:
School Bus Contracts:
Tours:
Stage Carriage:
Express Carriage:
Will the vehicle(s) travel abroad? If Yes, please provide full details i.e. total number of estimated days and countries to be visited:
If the risk involves use in the vicinity of aircraft, please provide details:
Are all drivers aged 25 or over?*
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Are any drivers aged 70 or over?*
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Do all drivers have a minimum 2 year full UK relevant license?*
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Yes No
If no, please provide full details:
Please advise of any
relevant drivers likely to affect the rating of the risk. eg. drivers with motoring
convictions etc:
Year
No. Vehicles
No. Accidents
AD Paid
TP Paid
AD O/S
TP O/S
Total Paid & O/S
Make/Model/Type
Seats inc. Driver
Value
Year
Registration
Cover
NCB Years
If you have any futher information in relation to your quotation, please provide it here:
