Personal Information
|
|
| Your Full Name |
Title First
Names and Surname |
| Trading Name |
only
complete this if you are buying the policy for a company
vehicle. |
| Address - Line 1 |
|
| Address - Line 2 |
|
| Address - Post Town |
|
| Address - Postcode |
|
| Your e-mail address |
|
| We may send you information from
time to time about insurance generally and special offers. If
you do NOT want to receive it check and
we'll only send details about this enquiry/policy. |
| Telephone number |
|
| Date of Birth |
|
Vehicle Information
|
|
| Make of Vehicle |
(Peugeot
E7 model not acceptable) |
| Model Of Vehicle |
|
| Registration Number |
|
| Date of Registration |
(Second
Hand vehicles are acceptable) |
| Date of Purchase/Lease/Finance |
(Must
be less than 90 days ago (contract hire/ finance gap) or 60
days ago ( back to invoice) |
| Purchase Cost |
Up to (The maximum benefit depends on the purchase cost you
enter. Please remember that Taxis/ driving school use have
lower maximum values) |
| Exact Purchase Cost |
£ |
| Method of Purchase |
|
| If bought on Finance |
Loan Amount £Loan
Term (years):
Finance House |
| If on Hire/ Lease |
Monthly repayment (up to £1,000 ex vat) £
Length
of contract (months):
Lease Finance House |
| Use of vehicle |
|
Policy Information
|
|
| Type of Policy |
Contract/ lease Hire not available for
Taxis: motorcycles/ motorhomes can only have BTI |
| Period of Cover |
|
| Policy Limit requested |
The maximum cover for Taxis/ driving
school is £10,000 unless on 'Back to Invoice' when it is
£15,000 |
|
|
|
|
