Minibus & Taxi Insurance - Quotation Request
Proposer's name
Company trading name
E-mail address
Telephone No
Postal address
Postcode
Contact name (if different from above)
About the Proposer
Date of birth
Sex
Marital status
Driving licence
Date Obtained
Do you have any convictions in the last 5 years
or drink driving convictions in the last 10 years?
If yes, please detail here including date of convictions,
codes, length of any disqualifiations and fines imposed
Any accidents in the last 5 years?
If yes, please detail the accident(s) here including
dates
Class of use required
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Public Hire
Private Hire
Contract Hire
Your annual mileage
Operating area
Insured persons (please
select then click 'move on' next to your selection)
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on
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on
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on
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on
Your spouse's
details
Name
Date of birth
Occupation
Please let us know here about your spouse's convictions in the
last 5 years (10 years for drink driving convictions) including
date of convictions, conviction codes, length of any disqualifiations
and fines imposed.
If your spuse has had any accidents please detail here including
dates
Now please click
here to complete your vehicle details
Named driver
details (maximum
of 4 permitted)
Named driver no.1
Name
Date of birth
Occupation
Relationship to you
No of years taxi experience
Driving licence
Date obtained
Please let us know here about this driver's convictions in the
last 5 years (10 years for drink driving convictions) including
date of convictions, conviction codes, length of any disqualifiations
and fines imposed.
Any accidents? please detail here including dates
Now please complete the details for driver no. 2 if applicable click here
to complete your vehicle details.
Named driver no. 2
Name
Date of birth
Occupation
Relationship to you
No of years taxi experience
Driving licence
Date obtained
Please let us know here about this driver's convictions in the
last 5 years (10 years for drink driving convictions) including
date of convictions, conviction codes, length of any disqualifiations
and fines imposed.
Any accidents? please detail here including dates
Now please complete the details for driver no. 3 if applicable click here
to complete your vehicle details.
Named driver no. 3
Name
Date of birth
Occupation
Relationship to you
No of years taxi experience
Driving licence
Date obtained
Please let us know here about this driver's convictions in the
last 5 years (10 years for drink driving convictions) including
date of convictions, conviction codes, length of any disqualifiations
and fines imposed.
Any accidents? please detail here including dates
Now please complete the details for driver no. 4 if applicable click here
to complete your vehicle details.
Named driver no. 4
Name
Date of birth
Occupation
Relationship to you
No of years taxi experience
Driving licence
Date obtained
Please let us know here about this driver's convictions in the
last 5 years (10 years for drink driving convictions) including
date of convictions, conviction codes, length of any disqualifiations
and fines imposed.
Any accidents? please detail here including dates
Now,
please give us some information about the vehicle...
Make of Vehicle
Model (inc. L, GL etc)
Engine size (cc)
Registration Date
No of seats including the driver
Are there any communication devices in the vehicle
(inc mobile phone)?
Has the vehicle been modified in any way?
if yes, please give details
Value
Cover Required From
No Claims Discount available
or
Was this NCD accumulated on a taxi?
Protected NCD required?
Overnight Parking
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Locked Garage
Driveway
Private Land
Road
Cover required
Are you the...
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Owner of the vehicle
Keeper of the vehicle
Driver of the vehicle
Preferred Payment Method
choose >>>
Credit Card
Debit Card
Cheque
Direct Debit
