Bike Insurance Form

How did you hear about us?

If by a friend, family or referrer please state their name and number.

Name:

Number:

Personal Info

Title: *

First Name: *

Surname: *

Birthday:*

Date:

Month:

Year:

House Number/Name: *

First Line of Address: *

Postcode: *

Marital Status: *

Employment Status: *

What is your occupation:

What is the nature of the business:

If you are a Student, which subject are you studying:

If Self Employed, nature of Business/ Sole Trader or Limited Company:

Company name:

Home Owner: *

Any Children Under 16: *

Riding History

Type of motorcycle licence: *

Period Licence held for: *

What date was the Licence obtained:*

Date:

Month:

Year:

When Did You Pass your CBT Test:*

Date:

Month:

Year:

Years continuously insured as a rider:

Member of biking organisation:

Any advanced riding qualifications:

Were you born in the UK:*

If No, when did you last become a UK resident:

Date:

Month:

Year:

Use of any other vehicles:

Have you had any motor accidents, claims or losses in the past 5 years, no matter who was at fault or if a claim was made:

Have you had any driving related convictions, endorsements, penalties, disqualifications or bans in the past 5 years:

Vehicle Details

Vehicle Registration: *

Approximate value of the vehicle right now:

Manufacturer:

Model:

Registration Year:

Alarms - Immobiliser:

Engine Size (CC):

Transmission:

Does the vehicle have any modifications: *

Yes

Please advise on what modifications have been made to the car

Date of purchase:*

Date:

Month:

Year:

Not yet purchased

Registered Keeper:*

Legal Owner:*

Is the bike impounded with the police?

Vehicle Usage

Where is the vehicle kept during the day:*

Where is the vehicle kept overnight:*

Is the vehicle kept at the same address:*

If No, what is the full address of where the vehicle is kept:

Have you or any of the drivers ever had insurance declined, cancelled or special terms imposed:*

Use of vehicle:*

Estimated Annual Mileage:*

Type of Cover:*

Any no claims discount:*

How did you earn your no claims discount:

Was this NCD earned in the UK:

Would you like to protect your NCD:

What voluntary excess would you like:*

How do you normally pay for insurance:*

Please provide your Current/Previous Insurer name:

When would you like the policy to start:*

Date:

Month:

Year:

By clicking this checkbox, you unambiguously agree to give your full consent for us to use the data provided compliantly with the Data Protection Act 1998. Your data will be stored in our database and shared with offline and online markets to provide you with potentially the cheapest quote.

Bike Insurance Quotation Form

Bike Insurance Quotation Form

Personal Info

Contact Info

Riding History

Vehicle Details

Vehicle Usage