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Please
Read This Statement Before Completing The Form. |
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The
quotations we provide you will be based on the following: |
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1. |
No drivers have had any
accidents, claims or received any motoring convictions. |
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2. |
No drivers have any disabilities
or illnesses which can affect their driving or which have been notified to DVLA. |
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3.
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There are No modifications to the
vehicle (E.G. Alloy Wheels, Bodykits, Engine, Exhaust , Etc).
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4. |
The vehicle is not left hand
drive or has been imported to the UK. |
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5. |
There are no
more than 4 named drivers on the vehicle. Any driver policies are
available but no intro discount can be given. |
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Please Confirm You
Have Read And Comply With The Above Statement
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N.B.
If
you cant agree with the above statement or are not sure about the statement
then please ring us on 01288 353999 where we will
be more than pleased to offer a quotation over the phone.
Second Car
Insurance Quotation Form
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Vehicle Details |
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Make: |
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Model: |
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Engine size (CC's): |
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Year of make: |
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Exact Model Type (I.E. GL, LX,
Sport TD,
etc): |
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Registration Number (If Known): |
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No of doors:
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Body type:
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Fuel type: |
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Transmission: |
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Value: |
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Security: |
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Date of purchase: |
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Overnight parking: |
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Drivers: |
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Proposer's
Details |
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Title: |
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First name: |
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Surname: |
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Date of birth: |
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How often do you use this car: |
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Occupation: |
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Employers business: |
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Marital status: |
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Type of licence: |
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Date passed test (If
provisional, how long held): |
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Do you have use of any other
car: |
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Use of vehicle: |
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Annual mileage
of vehicle: |
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Are you a homeowner: |
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First Additional Driver Details (If Applicable) |
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Title: |
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First name: |
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Surname: |
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Date of birth: |
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How often do you use this car: |
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Occupation: |
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Employers business: |
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Marital status |
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Type of licence |
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Date passed test (If
provisional, how long held): |
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Do you have use of any other
car: |
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Use of vehicle: |
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Second
Additional Driver Details (If Applicable) |
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Title: |
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First name: |
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Surname: |
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Date of birth: |
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How often do you use this car: |
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Occupation: |
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Employers business: |
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Marital status: |
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Type of licence: |
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Date passed test: (If
provisional, how long held): |
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Do you have use of any other
car: |
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Use of vehicle: |
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Third Additional Drivers Details (If Applicable) |
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Title: |
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First name: |
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Surname: |
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Date of birth: |
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How often do you use this car: |
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Occupation: |
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Employers business: |
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Marital status |
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Type of licence: |
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Date passed test: |
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Do you have use of any other
car: |
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Use of vehicle: |
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General Cover
Details |
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Cover required: |
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Years No Claims Bonus on this
vehicle: |
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Years No Claims Bonus on your
first vehicle: |
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Do you require No Claims Bonus
protection: |
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Postcode where vehicle kept overnight: |
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Current insurers (If Applicable): |
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Renewal/Target premium: |
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Renewal/Start date: |
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Your Contact Details |
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Contact name: |
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Phone number: |
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Address: |
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Email address: |
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How would
you like us to contact you with our best quotation: |
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