Agricultural
Vehicle Insurance - Quotation Request
Proposer's Name
E-mail address (required)
Trading as
Address
Postcode
Telephone No
Fax No (optional)
Contact Name
General Particulars
1) Have you the Proposer or any Partner or Director ever been
convicted of or charged (but not yet tried) with a criminal offence?
or been declared Bankrupt or Insolvent?
2) Have you the Proposer or any Partner or Director for the business
now being propsed or for any previous business ever been insured
for any of the risks now being proposed?
if yes please give details below of the name(s), trading name(s)
and insurer(s)
Name(s) and trading name(s)
Insurer(s)
Vehicles to be Insured
Click 'move on' at any time that you have completed a section
Vehicle 1
Make and model/type
Year of manufacture
Cubic capacity
Gross Vehicle Weight
No of passenger seats
Estimated value (£)
Registration mark or identification no
NCD (years) at this renewal
Cover required
select >>>
Comprehensive
Third Party Fire and Theft
Third Party Only
Vehicle 2 or
move
on
Make and model/type
Year of manufacture
Cubic capacity
Gross Vehicle Weight
No of passenger seats
Estimated value (£)
Registration mark or identification no
NCD (years) at this renewal
Cover required
select >>>
Comprehensive
Third Party Fire and Theft
Third Party Only
Vehicle 3 or
move
on
Make and model/type
Year of manufacture
Cubic capacity
Gross Vehicle Weight
No of passenger seats
Estimated value (£)
Registration mark or identification no
NCD (years) at this renewal
Cover required
select >>>
Comprehensive
Third Party Fire and Theft
Third Party Only
Vehicle 4 or
move
on
Make and model/type
Year of manufacture
Cubic capacity
Gross Vehicle Weight
No of passenger seats
Estimated value (£)
Registration mark or identification no
NCD (years) at this renewal
Cover required
select >>>
Comprehensive
Third Party Fire and Theft
Third Party Only
Vehicle 5 or
move
on
Make and model/type
Year of manufacture
Cubic capacity
Gross Vehicle Weight
No of passenger seats
Estimated value (£)
Registration mark or identification no
NCD (years) at this renewal
Cover required
select >>>
Comprehensive
Third Party Fire and Theft
Third Party Only
Vehicle 6 or
move
on
Make and model/type
Year of manufacture
Cubic capacity
Gross Vehicle Weight
No of passenger seats
Estimated value (£)
Registration mark or identification no
NCD (years) at this renewal
Cover required
select >>>
Comprehensive
Third Party Fire and Theft
Third Party Only
Vehicle 7 or
move
on
Make and model/type
Year of manufacture
Cubic capacity
Gross Vehicle Weight
No of passenger seats
Estimated value (£)
Registration mark or identification no
NCD (years) at this renewal
Cover required
select >>>
Comprehensive
Third Party Fire and Theft
Third Party Only
Vehicle 8 or
move
on
Make and model/type
Year of manufacture
Cubic capacity
Gross Vehicle Weight
No of passenger seats
Estimated value (£)
Registration mark or identification no
NCD (years) at this renewal
Cover required
select >>>
Comprehensive
Third Party Fire and Theft
Third Party Only
Vehicle 9 or
move
on
Make and model/type
Year of manufacture
Cubic capacity
Gross Vehicle Weight
No of passenger seats
Estimated value (£)
Registration mark or identification no
NCD (years) at this renewal
Cover required
select >>>
Comprehensive
Third Party Fire and Theft
Third Party Only
Vehicle 10 or
move
on
Make and model/type
Year of manufacture
Cubic capacity
Gross Vehicle Weight
No of passenger seats
Estimated value (£)
Registration mark
NCD (years) at this renewal
Cover required
select >>>
Comprehensive
Third Party Fire and Theft
Third Party Only
If any of the above vehicles are registered under the Limited
Class of Use Act 1994, please state vehicle numbers below
About
Trailers
Is cover under this section required
if 'no' please click
here
Do you require attached trailer cover for attachments
exceeding £10,000
if 'yes' please give details below
Type of Trailer or Attachment
Estimated Value (£)
Do you require detached trailer cover?
if 'yes' please give the following details for all trailers owned
by you or in your custody or control
Total value (£)
Total number
Maximum value of any one trailer (£)
Level of detached trailer cover required
Fire & Theft
Accidental Damage, Fire & Theft
Further
information
Are any of the above vehicles owned by anyone other
than you?
if 'yes' please state vehicle numbers
Will any of the vehicles be used for any purpose
other than farming?
Do you require Temporary Replacement Vehicle cover
whilst your vehicle (up to 7.5 tonnes GVW) is off the road following
accidental damage, fire or theft (available with comprehensive
cover only)
if 'yes' with which vehicles
Driver
details
To the best of your knowledge will the vehicles be driven by
any person who:
a) has any physical or mental defect or suffers from diabetes,
epilepsy or any heart complaint?
b) has been convicted of any motoring offence (including fixed
penalty offences) during the past 5 years, or has a prosecution
pending, other than for parking?
c) has had a licence suspended during the past 5 years?
d) is under 25 years of age?
if you have answered yes to any of the above driver questions
a-d, please provide details in the additional info box for the
driver(s) involved.
Driver 1
Full name
Date of birth
Date test passed
Additional info
Driver 2 or move
on
Full name
Date of birth
Date test passed
Additional info
Driver 3 or move
on
Full name
Date of birth
Date test passed
Additional info
Driver 4 or move
on
Full name
Date of birth
Date test passed
Additional info
Driver 5 or move
on
Full name
Date of birth
Date test passed
Additional info
Claims
Experience
How long have you been in business?
Has any insurer in respect of any business in which you have
been engaged ever:
a) declined a Proposal, not invited a renewal of a Policy, refused
to renew or cancelled a Policy?
b) imposed special conditions (e.g. premium loading, cover restrictions
or increased excess)?
if you have answered yes to any of the above please
give details
Renewal date of present insurance (if applicable)
Preferred Payment Method
choose >>>
Credit Card
Debit Card
Cheque
Direct Debit
