COMMERCIAL VEHICLE QUOTE

1. Name of Proposer and Trading Title:
2. Address of the premises:
Post Code:	Tel. Number:
e-mail (if you have any):
3. Date of Birth (if individual):
4. Sex (if individual):	Marital Status (if individual):
5. Licence type :	How many years held (if individual):
6. Occupation of main driver:
7. Are you a home owner ?	Yes No
8. Have you been a resident in the UK for life? (main driver)	Yes No
if no, please provide full details

9. Vehicle make (i.e: Mercedes Sprinter):
10. Vehicle model (i.e:GTI)
11. Body type (i.e: Hatchback etc)
12. Carrying Capacity (Gross vehicle weight):
13. Year of manufacture:
14. Engine size: (cc)
15. Value:	£
16. Colour	Metallic: Yes No
17. Current mileage reading:	Annual mileage :
18. Any modifications from standard:	Yes No
19. Security (alarm, immobiliser) ?	Yes No
if "Yes" to 18 or 19 please provide details:

20. Cover required:	Comprehensive	Yes No
	Third Party Fire & Theft	Yes No
	Third Party Only	Yes No

21. Number of claim free years:
22. Previous insurers name:		Date Expired:
23. Use required:
	Social Domestic & Pleasure	Yes No
	Business use required	Yes No
	Carriage of Own Goods	Yes No
	Carriage of goods for Hire and Reward	Yes No

If you have ticked that business use is required, please provide number of business miles you do annually:
Please provide number of personal miles annually:
24. Authorised driving:

	Named drivers:	Age:	Occupation:	Main User:	Date U.K. driving test passed:	Usage:	Convictions, physical, defects, accidents/claims. If none state none
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25. Have you or any of the drivers had any claims?	Yes No
if "Yes" please provide details: (date of claim, description, payments to third party (if known) & own payment)
26. Have you or any of the drivers had any convictions, whether motor related or not, in the last 5 years?	Yes No
if "Yes" please provide details: (date of conviction, type of conviction, penalty points and fine details)
27. Have you or any of the drivers insured on this policy been refused insurance, or had special terms imposed? (disabilities of drivers)	Yes No
if "Yes" to please provide details:


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