Showmans Commercial Vehicle Insurance - Quote Request

PROPOSER

Title:*

First Name:*

Surname:*

Address:

City/Town:

County:

Postcode:

Country:

Home Telephone No:*

Work Telephone No:

Fax No:

Mobile No:

Email Address:*

Best time to contact you:

All Occupations

Full Time:

Part Time:

Employers Business:

Period of insurance from:

Annual Mileage:

VAT Registered?

Is the Vehicle kept in a locked garage over night at the address shown?

Homeowner:

Are you a member of the Showmans Guild?

Vehicle Details

Make & Model:

Engine Size:

Max. Carrying Capacity:

Gross Vehicle Weight (GVW):

Year of Manufacture:

Left or Right Hand Drive:

Date of Purchase:

Number of Seats:

Registration Number:

Type of Body:

Transmission/Fuel:

Main Colour:

Present Value:

Price Paid:

Maximum Mileage for Period of Insurance:

Is the vehicle imported?

Mileometer Reading:

Cover and Use

Cover:

Comprehensive
Third Party Fire & Theft

Please indicate the Class of Use required:

Social Domestic & Pleasure Only
Carriage of Own Goods 
Haulage

Ownership

If No, please give details here?

Drivers

Who is the main user of the above vehicle?

Who will drive?

Yourself Only
Yourself and Wife/Husband only
Yourself and up to three Named Persons

Give full details below in respect of YOURSELF and ALL others who drive

Full name

All occupations
(including part time)

Employers Business

Date of Birth

Type of licence

Time licence has been held?

Will any person (other than yourself) drive the vehicle?

(a) be under 25 years of age?  Yes No
(b) hold a provisional licence? Yes No
(c) have had less than one year's driving experience? Yes No

If 'YES' full details must be shown:

Are you a smoker?

Previous Experience

Have you or any person who may drive:-

(a) Lost an eye, limb or part of a limb, defective vision or hearing, any physical or mental infirmity, epilepsy, diabetes or any heart or other complaint? Yes No

(b) Any endorsement showing on their driving licence, or been convicted of any motoring offence during the past 5 years, or received a fixed penalty notice or have any prosecution pending? Yes No

(c) Been disqualified from driving or ever had their licence revoked? Yes No

(d) Been refused any motor vehicle insurance or continuation thereof or been required to pay an increased premium or had special conditions imposed by any motor insurer? Yes No

(e) During the last 5 years been involved in any accident, loss or claim irrespective of blame? Yes No

(f) Do you hold or have you ever held motor insurance? Yes No

(g) Are you claiming no claims discount? Yes No

If 'YES' give full details, including dates, circumstances and cost of any claims.
If 'YES' to disabilities have you advised DVLA?