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Commercial Vehicle (3.5 Tonnes and Under)
Name
Date of Birth
Telephone Number
Email Address
Occupation
Marital Status
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Married
Single
Separated
Divorced
Co-Habiting
Widow or Widower
Correspondence Address
Vehicle Registration
Vehicle make
Vehicle model
Security
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None
Thatcham Cat 1 Immob/Alarm
Thatcham Cat 2 Immob/Alarm
Tracker
Registered Owner
Storage Address (if different from above)
Kept at/in
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Road
Off Road
Garaged
Secure Compound
Vehicle Value
No. of seats
Left Hand Drive
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Yes
No
Business Type (e.g. Construction)
Employment status
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Employed
Self Emoployed
Licence Type
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Full UK
EU Licence
International
European (not EU)
Number of years resident in UK
Annual Mileage
Have you had any claims within the last 5 years
Do you have any current convictions on your licence or convictions yet to be added or confirmed
Do you have dissabilities reportable to the DVLA
Number of years no claims on a commercial vehicle policy
Number of years no claims on other vehicle
Is the vehicle sign written
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Yes
No
Is the vehicle modified in any way from the manufacturers standard
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Yes
No
Numbers of months trading
Total number of commercial vehicles owned
Are hazardous or dangerous goods carried
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Yes
No
Use required
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Carriage of own goods
Social, Domestic & Pleasure
Cover required
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Comprehensive
Third Party, Fire and Theft
Third Party Only
Would you like a quotation for optional Breakdown cover?
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Yes
No
Would you like a quotation for optional Legal Expenses cover
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Yes
No