UK self drive hire insurance quotation form

Business Details

From (e-mail address)

Name of Company

Owners/Partners/Directors

Address

Name	Age

Postcode

Postcodes of other sites

Telephone no

No years Established

Years trading from the main premises

Is SDH main income?

If 'No' what is?

Do you operate a new vehicle
franchise?

If 'Yes' What

Do you operate a motor trade
policy?

Insurer/cover

No of manual/Clerical Staff
No with 3+ years SDH exp

How many trade
plates do you have?

Current Insurance

Inception/ Renewal Date		Current Insurer
Cover required		Excess Level (min £500)
Current rating basis

Current vehicle schedule

Type	No	Vehicle Age Span		Vehicle Value Span
Cares under 2000cc		From	To	From £	To
Cars 2000cc - 2500cc		From	To	From £	To
Com Vehicles < 3.5T GVW		From	To	From £	To
Com vehicles 3.5T - 7.5T		From	To	From £	To
People Carriers^*		From	To	From £	To
No Minibuses 9-17 seats^*		From	To	From £	To
*^ including driver**

Hire Details

Projected turnover : Conventional Insurance £		Hirers Own £
Projected utilisation of hire fleet next year	%	Average Hire period
What percentage of your hires are insured using customers insurance			%
Any 'Credit Hire' Percentage if 'Yes'	% Foreign trips / year

Business History

No of vehicles

Conventional Turnover

Hirers own insurance

No of hire days

2000-2001

Cars
Others

1999-2000

Cars
Others

1998-1999

Cars
Others

Additional Benefits

Is social domestic and pleasure use by employees		Ages of ALL drivers
If 'Yes' a road-risks form is needed - please provide fax no here If 'No' please provide current insurer details policy no expiry

Claims history for last 3 years

Full vehicle list

(Make, model, engine size, seats, value and date registered)

The form is fully completed

Declaration I have completed the form to the best of my knowledge and belief. I have made a full disclosure of all material facts. I have read and understood the Important information below. I understand that there is no cover in force until confirmed by B. Portwood & Co Ltd, a satisfactory proposal form completed and accepted and payment of the premium made - either in full or an instalment plan set up acceptable to B. Portwood & Co Ltd.

Self drive hire insurance form