Quote4Insurance
Motor Trade Insurance Quotation
Section 1 - Client Details
Full Trading Name
Title
Mr
Mrs
Miss
Rev
Dr
First Name
Surname
Contact Telephone Number
Email
Business Address
Town
City
County
Post Code
Cover Required
Best Time to Call
Section 1 - Address for Correspondence ( If different from above )
Address
Town
City
County
Post Code
Contact Telephone Number
Email
Section 2 -
Nature of Business
Sales
Yes
No
-- Select --
Service
Yes
No
-- Select --
Mechanical Repairs
Yes
No
-- Select --
Recovery
Yes
No
-- Select --
Mobile
Yes
No
-- Select --
Salvage/Scrap Vehicles
Yes
No
-- Select --
Percentage of turnover relating to repairs
Percentage of turnover relating to tyre fitting
Other
How many years in Motor Trade ?
When was business established ?
Section 3 -
Do you specialise in Selling, service or Restoring
Sports, high performance, high value, (over 20k) or modifying vehicles?
Yes
No
-- Select --
Veteran / Vintage / Classic Cars ?
Yes
No
-- Select --
Agricultural vehicles or Contractor's Plat ?
Yes
No
-- Select --
Buses or Coaches ?
Yes
No
-- Select --
Vehicles of 4 tons G.V.W. or more ?
Yes
No
-- Select --
Manufacture or Remanufacture of tyres, vehicle parts of accessories ?
Yes
No
-- Select --
Section 4
-
Details of Principal / Partners / Directors / Employees
Name
D.O.B
Status
Occupation
Manual
Full/Part
Partner
Director
Employee
Principal
Select
Yes
No
Select
Full
Part
Partner
Director
Employee
Principal
Select
Yes
No
Select
Full
Part
Partner
Director
Employee
Principal
Select
Yes
No
Select
Full
Part
Partner
Director
Employee
Principal
Select
Yes
No
Select
Full
Part
Partner
Director
Employee
Principal
Select
Yes
No
Select
Full
Part
Work away other than collection or delivery ?
Yes
No
-- Select --
Does work away involve Blowlamps, blow touches or hot air guns ?
Yes
No
-- Select --
Does work away involve Welding or frame cutting ?
Yes
No
-- Select --
Do you wish to include cover for heat work away
Yes
No
-- Select --
Section 5 - Claims Details
Claims details of last 5 years
Section 6 -
Has Proposer or any Director / Partner in the business had ?
Proposal of Insurance declined, cancelled, or refused ?
Yes
No
-- Select --
Convicted or charged with a criminal offence ?
Yes
No
-- Select --
Special terms if increased premium loadings ?
Yes
No
-- Select --
Renewal Refused or policy cancelled ?
Yes
No
-- Select --
Declared bankrupt or insolvent ?
Yes
No
-- Select --
Any other facts to be disclosed
Yes
No
-- Select --
Details:
How did you hear of
Quote4insurance
?
e.g. Name of magazine/newspaper you saw our advert in, T.V., radio, Teletext,diverted from other site = please name site / search engine, internet advert etc.