Motor Trade Insurance Quote Form

Your details

Premises Details

Business Details

Cover Required

Drivers/Claims/Convictions

Vehicle Details

Extensions

Cover Required

Your details

Clegg Gifford Quote Form

Name

Email Address

Telephone number

Home Address

Postcode

When would you like to be covered from?

Your Premises

Please indicate which of the following locations you work from:

Home

Mobile

Premises

Please indicate the type(s) of premises you operate from:

Workshop

Lockup

Forecourt

Showroom

Yard

Open Site

Other (Please specify)

Business Address

Postcode

What is your premises maximum vehicle capacity?

What is the maximum number of vehicles that will be on the policy? (MID Allowance)

How many months have you been at these premises?

Cover Required

What level of cover do you need

Limit of indemnity required on your own vehicles (£)

Total maximum value of own vehicles (£)

Limit of indemnity required on your customer vehicles (£)

Total maximum value of customer vehicles (£)

How much excess do you wish to pay (£)

Insurance History

How many years No Claims Bonus (NCB) do you hold?

Why do you not hold any NCB?

Your NCB

When does your NCB expire?

What type of insurance was it earned on?

What was the name of your previous insurer?

Do you require NCB protection?

Drivers

List all drivers you wish to be covered under the policy. Select ‘Add a new driver’ to list up to 10 in this form. If you need more, please contact us.

Name

Date of Birth

Relationship to proposer

Home address

Length of residency (years)

Type of License

Length license held (years)

Gross Vehicle Weight allowed (KG)

Maximum Cubic Capacity (cc)

For what purpose will this driver use the vehicles?

Driving Convictions & Claims

Convictions

Has any driver been convicted of ANY motor offences (other than parking) in the last 5 years OR have a prosecution or enquiry pending?

Which driver does this relate to? (Number in list)

Date of conviction

Conviction code

You can find a list of endorsement codes on the gov.uk website

Fine amount (£)

Points received

Was there a disqualification?

Length of ban (months)?

Claims

Has any driver had any claims/accidents in the last 5 years?

Which driver does this relate to? (Number in list)

Date of claim

Description of accident and claim

Total cost (£)

Was it a personal claim?

Was it the fault of the driver?

Vehicle Details

List all vehicles you wish to be covered under the policy. Select ‘Add a new vehicle’ to list up to 10 in this form. If you need more, please contact us.

Registration number

Vehicle make

Vehicle model

Value of Vehicle (£)

Owned by (Name)

Postcode where kept

Are any of the vehicle leased for a minimum initial period of less than 12 months

If yes please give details

Please select the types of vehicles that are to be driven

Sports/high performance vehicles

Vehicle group?

Commercial vehicles over 3.5 tonnes

Gross Vehicle Weight (GVW) required (KG)

Motorcycles

CC Limit

Max Value (£)

Classic cars over 25 years

Imports (Please specify)

Modified vehicles (if yes provide details)

Please provide details for imports and/or modified vehicles

Horseboxes / Agricultural vehicles / Plant / Machinery

Rally / Track / Kit cars / Quads / Trikes

Recovery trucks

Type of use for recovery

Transporters in excess of 2 vehicles

American / Canadian

Motorhomes

Vehicles with more than 7 seats

Taxis

Extensions

Demonstration cover required

Accompanied / Unaccompanied

Windscreen cover required

Customer loan vehicles

If yes, how many?

Registration Numbers

Cover required

Any cover for driving other vehicles required?

If yes, what kind?

Declarations

Have you ever had a policy voided, cancelled, refused or had special terms applied?

Have you ever had a claim repudiated or refused?

Have you ever had any county court judgement (CCJ) served against you or entered into an individual voluntary arrangement in the past 5 years?

Have you ever been a director of a company which went into liquidation, receivership, been the subject of an administration order or declared bankrupt?

Have you suffered a disability that has a requirement to contact the DVLA but which has not been reported to the DVLA, or hold a restricted licence?

Have you ever been convicted of any criminal conviction not spent under the Rehabilitation of Offenders Act or do you have any prosecutions pending?

Have you ever been a director or business partner of a business or company other than the motor trade business proposed here?

Have you been involved in vehicle rental, self drive hire, vehicle leasing, vehicles broking or accident claims management?

If you answered yes to any of the questions above, please provide details below:

You agree that you have read and understood your Duty of Disclosure

You agree that you have read and agree to our Privacy Policy and Terms, that we can process your information for the purposes of providing a quote, and that we can reply to you.

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Motor Trade Insurance Quote Form

Your details

Your Premises

Business Details

Business areas

Warning

Cover Required

Insurance History

Your NCB

Drivers

Driving Convictions & Claims

Convictions

Claims

Vehicle Details

Extensions

Declarations

Need help with this form?

What will you need?

Insurance Services

Company Information

Duty of Disclosure

Duty of Disclosure