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	Seating capacity 7 - 29 seats
	Individual vehicles or multi-vehicle policies
	Special liability sections for particular users such as nursing homes, charitable organisations, sports clubs, places of worship
	RAC breakdown recovery service included
	Legal defence costs, limit £5000 for motoring prosecutions (excluding drink, drugs and parking offences)
	Uninsured loss recovery service

For Private Hire click here

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If you would like to receive a quotation for the above scheme, please submit the form below. Please ensure that all relevant questions are answered.

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Data Protection Act, 1984. Your details will be stored on computer, only to handle your enquiry

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Address	Name Fax
Post Code	Email Telephone Number (including STD Code) Home
	Telephone Number (including STD Code) Work

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We are unable to accept crewbuses - vehicles with bench seats. All seats must be forward facing

Proposer:

Postcode where vehicle is kept:

Make

Model

Year	No of Seats (inc driver)

Value

Seatbelted?

Imported-LHD

Modifications

Use
Social Domestic and Pleasure Only
Voluntary - Charity
Business Use

If Business Use give details

Cover
Comprehensive
Third Party Fire and Theft

No Claims Discount - Number of years

Type of policy - Private Car or Other- if other give details

Drivers
Insured Only
Insured and Spouse
Named
Any driver aged 25 to 65

Driver details
All drivers must have been continuously resident in the UK for a minimum of two years
All drivers must have held a full UK licence applicable to the vehicle being driven for a minimum of two years
Drivers aged 70 or above are unacceptable
We are unable to accept unemployed persons

Name

DOB

Occupation (including type of business)

Type of Licence

Period Held

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Other Information

Accidents - Claims:

Convictions:

Disabilities:

Renewal Date:

Current Insurer:

Renewal Premium