Please complete this short questionnaire for an on-line quote.
Please Note, Quotations can only be given when ALL answers are completed in the white boxes.
About you
Name Title Home Phone E-mail
Date of Birth Sex Male Female
Please enter your Licensing Authority in the space provided below.
Are You a full time Owner/driver
yes no
Enter any other occupation. in the space provided below.
How Long since you passed your test?
How long have you owned a Taxi/Private hire vehicle?
How long have you been a Taxi/Private hire driver?
What was your previous occupation?
Have you had any accidents, claims or losses in the last 3 years, please give details of how it happened, estimated costs, and who was at fault
Have you had any convictions in the last 3 years, or are any pending?. Please give full details.
Who else will drive the vehicle? please give any claims or conviction details.
Have you Been convicted of driving under the influence of drink or drugs in the last 11 years?
Do you have any Medical condition, Physical defect, or DVLA referable condition?
Has any company ever declined proposal, Required an increased premium, (except inflationary increases) Increased your excess, cancelled or refused to renew your policy?
Make and Type of vehicle
Year of manufacture
Vehicle value
How many vehicles do you operate?
Are you the owner of this vehicle?
Is the vehicle "Plate" in your name?
Has the vehicle been modified in any way?
How many Years No Claims Discount do you have? (the answer MUST be given in years)
Who are your present insurers?