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Motor Fleet Insurance Quote Form

1
Your details
2
Your business
3
Your vehicles
4
Your drivers
5
Declarations

Your details

Are you able to confirm that you (as the proposer): *
  • have never had a proposal for insurance declined or special conditions imposed by any Insurer
  • have never been convicted of or charged (but not yet tried) with a breach of any health and safety legislation or any other criminal offence other than parking or speeding offences or offences which are spent under the Rehabilitation of Offenders Act 1974. (other than those disclosed)
  • are not subject to an outstanding County Court Judgement (or the Scottish equivalent)
  • are not subject to bankruptcy or insolvency orders which are either outstanding or have been discharged for less than 5 years

Your business

Check any that apply

Private vehicles

Please list all private vehicles to be covered under the policy. If you only need commercial vehicles, you can skip to the commercial section.

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Commercial vehicles

Please list all commercial vehicles to be covered under the policy. If you also need private vehicles, you can skip back to the private section.

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Your drivers

Are you able to confirm that this driver: *
  • has never had a proposal for insurance declined or special conditions imposed by any Insurer
  • has never been convicted of or charged (but not yet tried) with a breach of any health and safety legislation or any other criminal offence other than parking or speeding offences or offences which are spent under the Rehabilitation of Offenders Act 1974. (other than those disclosed)
  • is not subject to an outstanding County Court Judgement (or the Scottish equivalent)
  • is not subject to bankruptcy or insolvency orders which are either outstanding or have been discharged for less than 5 years
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Declarations

Are you able to confirm you (and anyone who will be insured by this policy): *
  • Has never had a policy voided, cancelled, refused or had special terms applied
  • Has never had a claim repudiated or refused
  • Has had no county court judgement (CCJ) served against you or entered into an individual voluntary arrangement in the past 5 years
  • Has never been a director of a company which went into liquidation, receivership, been the subject of an administration order or declared bankrupt
  • Has never suffered a disability that has a requirement to contact the DVLA but which has not been reported to the DVLA, or holds a restricted licence
  • Has not been convicted of any criminal conviction not spent under the Rehabilitation of Offenders Act or have any prosecutions pending
It is likely we can still help you obtain cover.

Need help with this form?

01204 84 84 81

What will you need?

  • Approx. 6 minutes
  • Details of your business
  • Details of your vehicles
  • Details of any driver(s)

For all your insurance needs.

Insurance Services

Company Information

Impact Insurance Services (Bolton) Limited are authorised and regulated by the Financial Conduct Authority. Firm Reference Number: 304613.
Registered Address: 67 Chorley Old Road, Bolton BL1 3AJ. Registered in England with company no. 04939219.
Members of the Society of Insurance Broking.

© Impact Insurance. All Rights Reserved.

Duty of Disclosure

Where the main use of the contract is private.

Your duty to give information

When applying for or amending your insurance policy, we and / or your insurer will ask a number of questions to assess the risk prior to agreeing cover. It is your duty to ensure that you answer all questions raised by insurers or us honestly and reasonably. These questions are designed to enable us or the insurer to obtain a comprehensive picture of the nature of the risk to be insured, and only by asking such questions and receiving answers which are given honestly and with reasonable care, can we or the insurer be in a position to offer terms which are designed to meet your demands and needs.

The reason why this is vital and extremely important is that if you fail to tell us or the insurer something when asked, or, if you answer carelessly or act deliberately or recklessly in making misrepresentations when answering questions, your policy may leave you with no insurance protection; insurers may not pay a part or all of your claim and may cancel your policy. You may find it difficult to re-arrange cover because you did not tell an insurer everything when asked, and you will have to disclose this fact when you reapply for insurance.

FAILURE TO ANSWER QUESTIONS HONESTLY AND REASONABLY, WHEN ASKED, MAY LEAVE YOU WITH NO COVER AND A CLAIM NOT PAID

Duty of Disclosure

Where the main use of the contract is commercial.

It is your duty to ensure that you provide a fair presentation of the risk to underwriters; the objective of a fair presentation is to give us all the information underwriters might need to quote the premium and decide what terms to apply.

You have a duty to disclose every material circumstance that you know or ought to know after a reasonable search. This applies before the cover is placed, when renewed and if altered at any time during the policy period. A circumstance is material if it would influence the underwriters decision whether to accept the risk, including terms and pricing.

If there is any doubt whether a circumstance is material to this risk, it should be disclosed as failure to disclose may entitle insurers to refuse to pay a claim or apply additional terms or reduce the claim payment.

The point of a fair presentation is that it is far better to declare everything at the time of a quotation than to let the insurer find things out at the time of a claim.

FAILURE TO DISCLOSE THESE FACTS MAY LEAVE YOU WITH NO COVER AND A CLAIM NOT PAID.