Policy Holder Name:

E-mail:

Business Address:


Number of Employees:

Insured Vehicles: Please note, all vehicles must be registered in Policyholder’s name or in the company name in order to be insured under the policy.
Make Model Registration Number Engine Size Estimated Value
Insured Drivers:
Name Date of Birth (ddmmyy) Any previous convictions? How many years have you held a driving license? How many years have
no claims have you had?*
*If you or one of your drivers have had an accident in the last 3 years, please fill in the details including date, circumstances, and cost incurred below.



Who were you previously insured with?

Do you work on Emergency Service Vehicles:

Do you drive customer vehicles in excess of £20,000:

Summary of Cover Covered
Road Risks x
Public Liability - Insured £5,000,000 limit of indemnity x
Products Liability - Insured £5,000,000 limit of indemnity x
Legal Expenses - Insured £100,000 x
Uninsured Loss Recovery x
Defective Workmanship x
Goods in Transit - We can include this. Just select the button to the right.
Employers Liability - We can include this. Just select the button to the right.

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