Motorcycle Quotation Form

Please fill out the form below in as much detail as possible. Fields marked with a RED asterisk are mandatory - and will enable us to complete a valid quote for you.
Proposer`s Details
Title

Fore Names
Surname
Address
* Postcode *
Home Telephone
Home Fax Number
Work Telephone
Work Fax number
Mobile Telephone
* Email Address *
Present Insurance Details
Any Previous Insurance *
*Present Cover *
Present insurer

eg. Sun Alliance -Not your insurance broker

* Renewal date

* If No Renewal Date - Approx Start Date
Renewal premium £ For Comparison Only
Vehicle Details
* Make * eg.Honda
* "Exact" Model * eg.Fireblade .....
* Vehicle colour *
* Paint finish *
* Vehicle registration * M123 ABC
* Date 1st registered * dd/mm/yyyy
Number of seats
Wheel Configuration
Present value £
Vehicle modifications If Yes Give Details
Cubic Capacity c.c.
Fuel Type
Transmission Type
Turbo
Date Purchased
Purchase Price £
Is Vehicle Parallel Import?
* Estimated Annual Mileage *
*Current Speedometer Reading *
Vehicle Security

Type of immobiliser

If Approved-->

Manufacturer: Model:
Thatcham Catagory I OR II

Exact model if possible.

Type of alarm

If Approved-->

Manufacturer: Model:
Thatcham Catagory I OR II

Exact model if possible.

Type of tracker

If Approved-->

Manufacturer: Model:
Thatcham Catagory I OR II

Exact model if possible.

Type of Tagging eg. Alpha or Data.......
Additional Anti-Theft device used when not in use?

eg. Disc clamp (if yes additional discounts may apply).
* Where kept at night *
Post Code if different from Home Address
Where kept whilst at work
Post Code where kept whilst at work
New Insurance Details - Proposer
Personal
Type Of Usage
Who will drive ?
Type Of Cover
* Years BIKE No Claims Bonus *
Type Of Business
Sex
* Date Of Birth * dd/mm/yyyy
Present Age
Marital status
Residency in UK years
Country of origin Please specify ie (UK)
Do you own your home? Yes No
Proposers Occupation eg. Deisel Fitter
* Employment Status *
If "Employed or Self-Employed", employers Type of Business
 eg. Engine Manufacturer
If Proposer is the Business Owner - Type Of Business
 As Above.
Estimated Private Mileage
Estimated Business Mileage
Breakdown Membership
Do you smoke? Yes No
Do you drink? Yes No
Driving status
   
Licence
* Driving licence type *
Refusals or Special Terms Yes No
If YES give details
Date CBT Test Passed dd/mm/yyyy
CBT Certificate Number
* Period licence held years months *
Date Test Passed dd/mm/yyyy
Number of driving tests
Country licence issued Please specify ie (UK)
Car or Van Owner Yes No
* If yes, Car No Claims Bonus Years *
Claims Or Accidents
* Has Any driver been involved in a Claim or had an Accident in last 5 years
* Whether at fault or not
Claim / Accident 1 Yes No Brief Details
Claim / Accident 2 Yes No Brief Details
Claim / Accident 3 Yes No Brief Details
Claim / Accident 4 Yes No Brief Details
Claim / Accident 5 Yes No Brief Details
Convictions
* Has Any driver been convicted of any motoring offence in the last 10 years or have any prosecution pending
*
Conviction 1 Yes No Brief Details
Conviction 2 Yes No Brief Details
Conviction 3 Yes No Brief Details
Conviction 4 Yes No Brief Details
Conviction 5 Yes No Brief Details
Additional Driver Details
Are Any Additional Drivers To Be Incuded On This Form
Additional Rider 1 Yes No Date passed test dd/mm/yyyy
Additional Rider 1 Yes No Date passed test dd/mm/yyyy
Additional Driver 1 Yes No Date passed test dd/mm/yyyy
Additional Driver 1 Yes No Date passed test dd/mm/yyyy
Additional Driver 1 Yes No Date passed test dd/mm/yyyy
     

Additional Driver 1

Title

First name
Second name
Sex
Date Of Birth dd/mm/yyyy
Present Age
Marital status
Relationship to proposer
Residency in UK years
Country of origin Please specify ie (UK)
Occupation
Do you own your home? Yes No
Do you smoke? Yes No
Do you drink? Yes No
Driving status
Licence
Driving licence type
Period licence held years months
Date Test Passed dd/mm/yyyy
Number of driving tests
Country licence issued Please specify ie (UK)
Car or Van Owner Yes No
Navigation Only
To Return To Claims/Convictions
   
Navigation Only


To Return To Claims/Convictions
Additional Driver Claims Or Convictions
Claims - ADDITIONAL DRIVERS
Have ANY Additional Drivers Had Claims In Last 5 years
   
Additional Driver Claim 1
Which Driver View Driver
Date Of Accident dd/mm/yyyy
Incident Type
Description Of Accident
Full recovery Yes No
NCB affected Yes No
At fault Yes No
Personal Injury Yes No
Amount Claimed £
3rd Party Costs £
Whose Policy
Additional Driver Claim 2
Which Driver View Driver
Date Of Accident dd/mm/yyyy
Incident Type
Description Of Accident
Full recovery Yes No
NCB affected Yes No
At fault Yes No
Personal Injury Yes No
Amount Claimed £
3rd Party Costs £
Whose Policy
Additional Driver Claim 3
Which Driver View Driver
Date Of Accident dd/mm/yyyy
Incident Type
Description Of Accident
Full recovery Yes No
NCB affected Yes No
At fault Yes No
Personal Injury Yes No
Amount Claimed £
3rd Party Costs £
Whose Policy
Additional Driver Claim 4
Which Driver View Driver
Date Of Accident dd/mm/yyyy
Incident Type
Description Of Accident
Full recovery Yes No
NCB affected Yes No
At fault Yes No
Personal Injury Yes No
Amount Claimed £
3rd Party Costs £
Whose Policy
Additional Driver Claim 5
Which Driver View Driver
Date Of Accident dd/mm/yyyy
Incident Type
Description Of Accident
Full recovery Yes No
NCB affected Yes No
At fault Yes No
Personal Injury Yes No
Amount Claimed £
3rd Party Costs £
Whose Policy
Convictions - ADDITIONAL DRIVERS
Have ANY Additional Drivers Had Convictions In Last 10 years
   
Additional Driver Conviction 1
Which Driver View Driver
Offence date dd/mm/yyyy
Conviction date dd/mm/yyyy
Conviction code
Sample type
Sample level
Fine £
Disqualified period months
Points
Police Accident No
Additional Driver Conviction 2
Which Driver View Driver
Offence date dd/mm/yyyy
Conviction date dd/mm/yyyy
Conviction code
Sample type
Sample level
Fine £
Disqualified period months
Points
Police Accident No
Additional Driver Conviction 3
Which Driver View Driver
Offence date dd/mm/yyyy
Conviction date dd/mm/yyyy
Conviction code
Sample type
Sample level
Fine £
Disqualified period months
Points
Police Accident No
Additional Driver Conviction 4
Which Driver View Driver
Offence date dd/mm/yyyy
Conviction date dd/mm/yyyy
Conviction code
Sample type
Sample level
Fine £
Disqualified period months
Points
Police Accident No
   

Please ensure that all relevent questions are fully answered, and all questions marked with a red * are mandatory, as this is the only way an accurate quote can be produced.
To check, click the links below.

To return here, click the corresponding RED asterisk on the LEFT of the description field.

PostCode
E-mail
Any Previous Insurance
Present Cover
 Renewal date

In accordance with ABI regulations the quote will be sent to you by post with
a prospectus and proposal form.