Courier Motor Vehicle Quote
Target Premium
Name of current insurer/broker
Your Details
Surname
Forename
Title
Mr
Mrs
Miss
House Number/Name
Postcode
e-mail address
Description of trade: COURIER - ROAD Transport
Goods IN Transit Section (optional)
Goods in Transit Required
No
Yes
Goods in Transit Cover
-
£ 10000
£ 15000
£ 25000
£ 40000
UK All Risk
No
Yes
UK CMR
No
Yes
EU CMR
No
Yes
Public Liability Section
Is Public Liability Insurance Required?
No
Yes
If Yes,
What s the limit of cover required?:
-
£ 1 Million
£ 2 Million
£ 5 Million
If Yes,
Number of Drivers:
-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Is Employers Liability Required (compulsory if you employ anyone or if the business is a limited liability company unless there is a sole employee who owns > 50% share capital)
No
Yes
If Yes
: Drivers Wage Roll
£
If Yes
: Clerical Wage Roll
£
If Yes
, Number of Employees (clerical and manual)
-
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Breakdown Cover Wanted
Is motor breakdown with Homestart Cover Required:
No
Yes
Vehicle(s) Details
Make
Model (inc variant)
Year of Make
Seats (inc driver)
GVW
Value
Kept
-
H/J 91
J/K 92
K/L 93
L/M 94
M/N 95
N/P 96
P/R 97
R/S 98
T/V 99
VWX 00
XY51 01
02/52 02
03/53 03
04/54 04
05/55 05
06/56 06
07/57 07
-
1 tonne
2.1 tonne
3.5 tonne
7.5 tonne+
-
Garage
Drive
Road
Other
Modifications
Security Devices
Cover
Please select
Comprehensive
TPF&T
Third Party Only
(An excess will apply for damage/ theft claims)
No Claims Discount
-
1 Years
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years+
Years
Proof of bonus will be needed from previous insurance provider - usually renewal notice.
Earned On
-
Courier
Private Car
Haulage
Taxi
Motorcycle
Other
If your No Claims Discount is NIL please advise why. An introductory discount may apply if driving experience has been gained. For example, 5 years employed courier, new venture but max ncd earned on own private car policy etc.
Present Insurer
Renewal Date
Driver(s)
Who will drive the vehicle?
-
Insured Only
Named Driver
Any Driver over 25 (Full UK licence over 2 years)
Full Name
DOB
Date Obtained Licence
No. of years UK resident
Motoring Convictions
Motoring accidents/ claims
Disabilities
Years experience as courier
Details of Convictions/Accidents and Claims/ Disabilities including prosecutions pending
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