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Motorcycle Insurance
Title
Name
Email Address
Telephone number
Date of Birth
How long have you been resident in UK
Are you a member of the VMCC?
Please select...
Yes
No
If yes what is your VMCC Membership Number?
Gender
Please select...
Male
Female
Marital Status
1st line of address
Postcode
Are you a homeowner?
Please select...
Yes
No
Type of Dwelling
Are you currently in employment?
Please select...
Yes
No
Occupation
Type of business
Any additional job (if so please give details)
Have you had any insurance declined/refused or additional terms imposed?
Please select...
Yes
No
When do you wish cover to commence?
Expiry date of current policy (if applicable)
Has the rider been UK resident for 3 years or more?
Please select...
Yes
No
Use required
Please select...
Social, Domestic & Pleasure
Business
Business and Social Domestic and Pleasure
Cover required
Please select...
Comprehensive
Third Party, Fire and Theft
Third Party Only
Fire and Theft Only
Type of licence
Licence date
Do you hold a current, valid CBT
Please select...
Yes
No
How many other bikes do you ride?
Please select...
1
2
3
4
5
5+
Riding qualifications
Are you a member of any biking organisation
Please select...
Yes
No
If Yes please provide details
NCD to transfer onto this policy
How many other bikes do you own?
Please select...
1
2
3
4
5
5+
Do you have any NCD on other bikes?
Please select...
Yes
No
Do you have any medical conditions?
Have you made any claims in the last 5 years?
Please select...
Yes
No
If Yes please provide details
Have you had any driving convictions in the last 5 years?
Please select...
Yes
No
If Yes please provide details
Do you have any criminal convictions?
Please select...
Yes
No
Have you been disqualified?
Please select...
Yes
No
Make of bike1
Model of bike 1
Year
Engine size
Value
Registration
Are you the owner and registered keeper of the bike?
Please select...
Yes
No
When did you purchase the bike?
Does the bike have any modifications?
Please select...
Yes
No
If Yes please detail
Where is the bike stored when not in use
How is the bike secured?
Current Mileage
Expected annual mileage
Make of Bike 2
Model of Bike 2
Year
Engine Size
Value
Registration
Are you the owner and registered keeper of the bike?
Please select...
Yes
No
When did you purchase the bike?
Does the bike have any modifications?
Please select...
Yes
No
If yes please detail
Where is the bike stored when not in use
How is the bike secured?
Current Mileage
Expected annual mileage
Make of Bike 3
Model of Bike 3
Year
Engine Size
Value
Registration
Are you the owner and registered keeper of the bike?
Please select...
Yes
No
When did you purchase the bike?
Does the bike have any modifications?
Please select...
Yes
No
If Yes please detail
Where is the bike stored when not in use
How is the bike secured?
Current Mileage
Expected Mileage
Make of Bike 4
Model of Bike 4
Year
Engine Size
Value
Registration
Are you the owner and registered keeper of the bike?
Please select...
Yes
No
When did you purchase the bike?
Does the bike have any modifications?
Please select...
Yes
No
If yes please detail
Where is the bike stored when not in use
How is the bike secured?
Current Mileage
Expected Mileage
Other vehcles owned?
Other vehicles driven?
NCD on other vehicles?