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 |
|
| Telephone number |
|
Vehicle Information
|
|
| Make of Vehicle |
Vehicle
must be a car or light van |
| Model Of Vehicle |
|
| Registration Number |
|
| Date of Registration |
(Second
Hand vehicles are acceptable) |
| Please confirm the following |
Maximum age for finance GAP: 3 years.
Maximum age for back To Invoice: 5 Years |
| Date of Purchase/Lease/Finance |
(Must
be less than 3 months ago (contract hire/ finance gap) or 6
months 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 |
| 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 |
|
|
|
|
