COMMERCIAL VEHICLEQUOTATION

Renewal date Deadline date

Holding agent Last year’s premium £

Holding insurer Target premium

Proposer’s / Insured’s details

Proposer’s name Co. Registration no.

Proposer’s address

Website address Year established 1990

Current Arrangements

Business Description/Details of processes

Claims HistoryCertified Claims Experience attached – Yes/NoDate Details Amount paid Amount outstanding

Own Third party Own Third party

2011/2012 £ £ £ £

20010/2011 £ £ £ £

2009/2010 £ £ £ £

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COMMERCIAL VEHICLEQUOTATION

COVER Type of cover required Comprehensive / TPFT / TPO

Excess £ 100 ADFT

£ 50 WS

Driving Restrictions Insured Only / Named Drivers / Any Licenced Driver over 25

Use of Vehicles Social Domestic & PleasureBusiness of policyholder

Risk DetailsHave any vehicles been modified or had additional equipment added?If YES please provide details

Yes/No

Do any of the vehicles have additional security fitted in addition to the manufacturer’s standard fittings? If YES please provide details

Yes/No

Will any vehicles be used:i. To carry passengers or goods for hire

or reward?ii. To carry any hazardous goodsiii. Airside or in close proximity to

aircraft?iv. Outside UK for business purposes?If YES please provide details

Yes/No Yes/No Yes/No Yes/No

Drivers

Driver name Date of Birth Licence Type Period Occupation

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COMMERCIAL VEHICLEQUOTATION

Details of any drivers with motoring convictions within the past five

Driver name Conviction code

Conviction Date

Amount fined Disqualification period

Details of any drivers with physical disabilities or infirmities

Driver name Description of disability or infirmity Any driving licence restriction

Fleet managementName of Fleet Manager / person responsible?State qualifications, if any

Yes/No

Are there regular drivers’ licence reviews?How often are they reviewed?

Yes/No

Do you employ any agency drivers?Are they restricted to certain vehicles and if so please provide details?

Yes/No

Is there any driver training undertaken?If YES please provide details

Yes/No

Is there a disciplinary procedure in place for drivers involved in faults accidents?If YES please provide details

Yes/No

Any other fleet management procedures?

Yes/No

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COMMERCIAL VEHICLEQUOTATION

VEHICLE SCHEDULE

Make Model CC/GVW Registration

Year Registered

Cover NCB

Confidential Page 4 06/05/2023