Motor Trade 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 (Including any middle names): *

Birthday:*

Date:

Month:

Year:

House Number/Name: *

First Line of Address: *

Postcode: *

Employment Status: *

What is your occupation:

Trading Address (If Different):

Contact Info

Email:

Mobile: *

Phone:

Please contact me via:

Driving History

Type of License: *

Period Licence held for: *

Date of Licence obtained (Must provide if less than 5 years):*

Date:

Month:

Year:

Any motor accidents (fault or non-fault) or claims (whether claim made or not) in the last 5 years: *

Yes

No

Motor Accidents or Claim Details

1

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

2

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

3

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

4

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

In the last 5 years, has the driver had any motoring offences, including fixed penalties, convictions, driver awareness courses or disqualifications, or any pending prosecutions: *

Yes

No

Motor Conviction, Fixed Penalty or Disqualification Details

1

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

2

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

3

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

4

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

Vehicle Details

Do you do only Buying & Selling or vehicle recovery as well:

Do you do trading from home:

Are you trading as Limited Company or Sole Trader:

Do you have a trading name:

Do you have a recovery truck:

If yes, what's the make & model:

Have you ever had a Motor Trade policy before or this is first time:

If yes, who was your insurer previously:

Approximately how many cars you sell in a month:

vehicle registrations at present you hold:

What's the projected turnover for your business:

How many cars do you keep at a time in your possession:

Where do you keep the car:

If you have garage or driveway, how many cars it can hold at a time:

What is the level of indemnity:

What's the maximum individual value of the cars you hold:

Do you require demonstration cover:

Do you sale any Motor Bike, HGV, Classic or Sports cars or any vehicle over 3.5 ton?(If yes’ please specify):

What type of cover you prefer:

Do you have No Claim Bonus on Motor Trade policy:

Do you have No Claim Bonus on Private car (even presently in use on another car/van):

Would you like to pay ‘monthly or one off’ for your insurance :

When would you like the policy to start

Date:

Month:

Year:

Additional Driver

Would you like to add an additional driver

Yes

No

Additional Driver (1) Details

Title: *

First Name: *

Surname: *

Birthday:*

Date:

Month:

Year:

Additional Driver's Address (if known):

Additional Driver's Contact Number (if known)

Type of License: *

Period Licence held for: *

If less than 3 years, what date was licence obtained:

Date:

Month:

Year:

Is this second driver a business partner or employee:

Any motor accidents (fault or non-fault) or claims (whether claim made or not) in the last 5 years: *

Yes

No

Motor Accidents or Claim Details

1

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

2

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

3

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

4

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

In the last 5 years, has the driver had any motoring offences, including fixed penalties, convictions, driver awareness courses or disqualifications, or any pending prosecutions: *

Yes

No

Motor Conviction, Fixed Penalty or Disqualification Details

1

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

2

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

3

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

4

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

Would you like to add an additional driver

Yes

No

Additional Driver (2) Details

Title: *

First Name: *

Surname: *

Birthday:*

Date:

Month:

Year:

Additional Driver's Address (if known):

Additional Driver's Contact Number (if known)

Type of License: *

Period Licence held for: *

If less than 3 years, what date was licence obtained:

Date:

Month:

Year:

Is this second driver a business partner or employee:

Any motor accidents (fault or non-fault) or claims (whether claim made or not) in the last 5 years: *

Yes

No

Motor Accidents or Claim Details

1

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

2

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

3

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

4

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

In the last 5 years, has the driver had any motoring offences, including fixed penalties, convictions, driver awareness courses or disqualifications, or any pending prosecutions: *

Yes

No

Motor Conviction, Fixed Penalty or Disqualification Details

1

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

2

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

3

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

4

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

Would you like to add an additional driver

Yes

No

Additional Driver (3) Details

Title: *

First Name: *

Surname: *

Birthday:*

Date:

Month:

Year:

Additional Driver's Address (if known):

Additional Driver's Contact Number (if known)

Type of License: *

Period Licence held for: *

If less than 3 years, what date was licence obtained:

Date:

Month:

Year:

Is this second driver a business partner or employee:

Any motor accidents (fault or non-fault) or claims (whether claim made or not) in the last 5 years: *

Yes

No

Motor Accidents or Claim Details

1

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

2

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

3

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

4

Type:

Date of Accident:

Date:

Month:

Year:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

In the last 5 years, has the driver had any motoring offences, including fixed penalties, convictions, driver awareness courses or disqualifications, or any pending prosecutions: *

Yes

No

Motor Conviction, Fixed Penalty or Disqualification Details

1

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

2

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

3

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

4

Conviction Code:

Date of Conviction:

Date:

Month:

Year:

Points:

Fine(£) - if any:

Ban(months) - if any:

Additional Comment

Motor Trade Insurance Quotation Form

Motor Trade Insurance Quotation Form

Personal Info

Contact Info

Driving History

Motor Accidents or Claim Details

1

2

3

4

Motor Conviction, Fixed Penalty or Disqualification Details

1

2

3

4

Vehicle Details

Additional Driver

Additional Driver (1) Details

Motor Accidents or Claim Details

1

2

3

4

Motor Conviction, Fixed Penalty or Disqualification Details

1

2

3

4

Additional Driver (2) Details

Motor Accidents or Claim Details

1

2

3

4

Motor Conviction, Fixed Penalty or Disqualification Details

1

2

3

4

Additional Driver (3) Details

Motor Accidents or Claim Details

1

2

3

4

Motor Conviction, Fixed Penalty or Disqualification Details

1

2

3

4