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Please enter the company details

Name

Effective Date of Birth

Used for ratings that require a policyholder age

Are any of the Directors considered to be a Politically Exposed Person?

A "PEP" is someone who has a prominent position in life which gives them the power to make or influence major decisions ie an MHK or a Chief Executive of a large company.

Not yet known

Yes

Details

Company Structure

Registration Number

Address

Telephone Number

Email Address

Additional policyholder data

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Please enter the date you'd like the policy to start from in dd/mm/yyyy format

Start Date

Please enter the date you'd like the policy to start from in dd/mm/yyyy format

Vehicle Lookup

Match year or engine capacity using the prefixes Y and CC e.g. "CC2936 Y1987"

Please select your vehicle

Does your vehicle differ in any way?

If you couldn't find an exact match to your vehicle then choose the closet one and describe any differences here

Vehicle Details

Do you know the registration number?

Not yet known

Yes

Registration Number

Year of Manufacture

E.g. 2019

Number of Seats

Is the vehicle left hand drive?

Not yet known

Yes

Has the vehicle been modified?

Not yet known

Yes

Modification details

Purchase Date

Price Paid

Estimated Market Value

Loss / Claim history

Previous claims on insurance policies

Has the proposer or named driver had any accidents, claims or incidents in any vehicle in the last 5 years?

Not yet known

Yes

Claim details

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Add Claim

Driving Licences

Please detail all policyholders' driving licences

Licence details

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Add Driving Licence

Motoring conviction history

Details of historical motoring convictions

Has the proposer or named driver had any motoring convictions?

Not yet known

Yes

Conviction details

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Add Convictions

Medical condition history

Details of medical conditions

Has the proposer or named driver been diagnosed with any reportable medical conditions?

Not yet known

Yes

Medical condition details

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Add Medical Condition

No Claims Discount

How many years No Claims Discount do you currently have?

Please enter the number of whole years

Do you require No Claims Discount protection?

Not yet known

Yes

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