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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:
Carriage of own Goods - excluding any use for hire or reward?
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Carriage of Goods for Hire & Reward within a radius of 100 miles from which the vehicle is based?
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Carriage of Goods for Hire & Reward with unrestricted radius?
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If the risk involves the carriage of dangerous or inflammable goods, please provide fulld details
Will the vehicle(s) travel abroad? If Yes, please provide full details i.e. total number of estimated days and countries to be visited:
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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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
GVW
Value
Year
Registration
Cover
NCB Years
Make/Model/Type
Type
Value
Year
Cover
If you have any futher information in relation to your quotation, please provide it here:
