Quote4Insurance
Vehicle Fleet Quotation
Section 1 - The Policy Holder
Title
Mr.
Mrs.
Miss
Dr.
Rev.
First Names
Surname
Address
Town
City
Postcode
Telephone
Email
Occupation
Existing Insurance Company
Section 2 - Vehicles
Cover
Vehicle Type
Make Mode / Body Type
Reg. Mark Year
GVW/GTW Goods
CC
Yrs. No Claims
Value
Comprehensive
Third Party Fire & Theft
Third Party Only
Fire Theft & Accidental Damage
Fire & Theft Only
Private Cars
Goods-Carrying Vehicles
Special Type Vehicles
Agricultural Vehicles
Motor Cycles
Comprehensive
Third Party Fire & Theft
Third Party Only
Fire Theft & Accidental Damage
Fire & Theft Only
Private Cars
Goods-Carrying Vehicles
Special Type Vehicles
Agricultural Vehicles
Motor Cycles
Comprehensive
Third Party Fire & Theft
Third Party Only
Fire Theft & Accidental Damage
Fire & Theft Only
Private Cars
Goods-Carrying Vehicles
Special Type Vehicles
Agricultural Vehicles
Motor Cycles
Comprehensive
Third Party Fire & Theft
Third Party Only
Fire Theft & Accidental Damage
Fire & Theft Only
Private Cars
Goods-Carrying Vehicles
Special Type Vehicles
Agricultural Vehicles
Motor Cycles
Comprehensive
Third Party Fire & Theft
Third Party Only
Fire Theft & Accidental Damage
Fire & Theft Only
Private Cars
Goods-Carrying Vehicles
Special Type Vehicles
Agricultural Vehicles
Motor Cycles
Comprehensive
Third Party Fire & Theft
Third Party Only
Fire Theft & Accidental Damage
Fire & Theft Only
Private Cars
Goods-Carrying Vehicles
Special Type Vehicles
Agricultural Vehicles
Motor Cycles
Comprehensive
Third Party Fire & Theft
Third Party Only
Fire Theft & Accidental Damage
Fire & Theft Only
Private Cars
Goods-Carrying Vehicles
Special Type Vehicles
Agricultural Vehicles
Motor Cycles
Comprehensive
Third Party Fire & Theft
Third Party Only
Fire Theft & Accidental Damage
Fire & Theft Only
Private Cars
Goods-Carrying Vehicles
Special Type Vehicles
Agricultural Vehicles
Motor Cycles
Comprehensive
Third Party Fire & Theft
Third Party Only
Fire Theft & Accidental Damage
Fire & Theft Only
Private Cars
Goods-Carrying Vehicles
Special Type Vehicles
Agricultural Vehicles
Motor Cycles
Section 3 - Claims Information
Year
Number of Accidents
Paid AD
Paid TP
O/S AD
O/S TP
Section 4 -Security Devices
Registration Number
Security Device
Date Fitted
Section 5 -Drivers
Full Name
Age
Conviction Date
Conviction Code
Amount of Time
Period of Disqualified
Please complete the following in respect of any employees who will drive, who has been convicted during the last 3 years for Dangerous Driving ( DD10/20/30/40/50/60/70 ), Drink/Drugs ( DR 10/20/30/40/50/60/70 )or has ever been disqualified from driving
If none, then tick box