Car Insurance Quote This is a Car Insurance Quote form Do you know the Vehicle Registration Number?(Required) Yes No Then please enter it here to get started:(Required) Please specify the driver's side:(Required) Right Hand Drive (UK Standard) Left Hand Drive How many seats does the car have?(Required)123456789Transmission(Required)ManualAutomaticIs the car fitted with an alarm?(Required) Yes No Please select alarm(Required)Please Select an ItemBS 6803D.I.Y. installedFactory FittedNo AlarmProf. fittedIs the car fitted with an immobiliser?(Required) Yes No Please enter immobiliser(Required) Is the car fitted with a tracking device?(Required) Yes No Please enter tracking device(Required) Has the car been modified in any way e.g. changes to bodywork, adapted, extras fitted, changes to engine or wheels?(Required) Yes No Wheels/Tyres(Required) Alloy Wheels (non standard) Wider Tyres Wheel Trims Wheel Spacers Alloy Wheels (optional extra) Wider Wheels Spoilers/bodykits(Required) Complete Bodykit Rear Valance Rear Spoiler/Aerofoil Rear roof spoiler Front Spoiler/Airdam Side Skirts/Sills Body(Required) Additional windows Flared Wings Flared Wheelarches Fibreglass Panels Bonnet Bulge Strengthening Brackets Paintwork/stickers(Required) Decals/Stickers Non-standard Re-spray Paint Work – Non Standard Magnetic/Removable Signs Murals Increased performance badging Side stripes Suspension/Steering(Required) Hand controls Suspension changes Brakes(Required) Dual Controls Uprated Brakes Braided Brake Hoses Engine/transmission(Required) Air Filter Standard Engine Replacement LPG conversion Bored-out Engine Transmission Changes Nitrous Oxide Kit Fitted Exhaust System Changes Gearing Change Blueprinting Miscellaneous Engine Alterations Chipped/engine management system Non-standard Engine Turbocharging Supercharging Accessories(Required) Air conditioning Spot Lights Parking sensors Bull bars Tinted windows Removal/Replacement of seats Dashboard changes Upholstery Changes Satellite Navigation Equipment Fog lights High level/Extra brake lights Non-standard EngineAltered Pedal Configuration Sunroof Rally lights Car phones Towbar Roof rack Driving lights Wheelchair modifications Sports steering wheel Have you bought the car yet?(Required) Yes No When was the car purchased?(Required) DD dash MM dash YYYY When will the car be purchased?(Required) DD dash MM dash YYYY How much did you pay for the vehicle?(Required)Please enter a number greater than or equal to 1.How much do you expect to pay for the vehicle?(Required)Please enter a number greater than or equal to 1.What is the current market value of the vehicle?(Required)Please enter a number greater than or equal to 1.Who is the legal owner of the vehicle?Please Select an ItemProposerSpouseCivil PartnerCompanyLeasedOtherAre you (or will you be) the registered keeper of the vehicle?(Required) Yes No Total number of vehicles registered to your household (not including this one)(Required)0123456789+Are you a member of a motoring organisation?(Required) Yes No What motoring organisation are you a member of?(Required)Please Select an ItemAAAA and IAMAA and RACBritannia RescueGreen FlagIAM – Motorcycle TestIAM RoadsmartIAM RoadsmartIAM and RACOtherROSPA Advanced Driving TestRoyal Automobile ClubThe AAVehicle Make/Manufacturer(Required)Please Select an ItemACAIXAMALFA ROMEOModel of Vehicle(Required) Year of Manufacture(Required) Engine Capacity(Required) Use of the CarWhat will your car be used for?(Required)Please Select an ItemSocial Domestic and Pleasure OnlySocial, Domestic and Pleasure, including CommutingBusiness use by the policy holder (Class 1)Business use by the policy holder and their spouseBusiness use by any driver (Class 2)Commercial travelling (Class 3)What is the estimated annual mileage?(Required) Where is the car normally parked overnight?(Required)Please Select an ItemRoadLocked GarageDrivewayIs the vehicle kept at the policy holder's address?(Required) Yes No Please enter the postcode of where the car is kept(Required) Your PolicyWho will be insured to drive the vehicle?(Required)Please Select an ItemPolicy Holder OnlyNamed DriversPolicy Holder and SpouseAny Driver over 30Any Driver over 25What is the level of cover do you require?(Required) Comprehensive Third Party, Fire and Theft Third Party Only What level of voluntary accidental damage excess are you willing to accept?(Required)How many years No Claims Discount do you have?(Required)Please enter a number from 1 to 10.Do you personally have access to any other vehicles?(Required)Please Select an ItemNo access to any other vehiclesOwn other carOwn or have use of a motorcycleOwn or have use of a vanNamed driver on another carCompany Car (Excluding Social Use)Company Car (Including Social Use)When would you like your car insurance policy to begin?(Required) DD dash MM dash YYYY How did you pay for your previous insurance?(Required) Pay in full Direct Debit How would you like to pay?(Required) Pay in full Direct Debit Your Personal DetailsTitle(Required)MrMissMrsMsMxDoctorProfessorSirFirst Name(s)(Required) Surname(Required) Gender(Required) Male Female Date of Birth(Required) DD dash MM dash YYYY Have you been a permanent resident of the UK since birth?(Required) Yes No When did you become a UK resident?(Required) DD dash MM dash YYYY Marital Status(Required)SingleMarriedDivorcedWidowedCivil PartneredAre you a homeowner?(Required) Yes No Contact InformationHouse name or number(Required) Street(Required) Town(Required) Postcode(Required) What type of property is this?(Required)Please Select an ItemHouseBoat/BargeCaravanChaletFlatHalls of ResidenceHouseboatLicensed PremisesMarried QuartersNo Fixed AbodeSquatStatic CaravanDaytime telephone number(Required) Evening or mobile phone number(Required) Email address(Required) Employment InformationWhat is your employment status?(Required)Please Select an ItemEmployeeClub or AssociationDirectorFull Time EducationGovernmentHousePersonLimited CompanyOtherProprietor or PartnerRetiredSelf EmployedUnemployedStudentWhat is your occupation?(Required) Do you have a Part-Time or an Additional Job?(Required) Yes No Part-time Employment InformationWhat is your part-time employment status?(Required)Please Select an ItemEmployeeClub or AssociationDirectorFull Time EducationGovernmentHousePersonLimited CompanyOtherProprietor or PartnerRetiredSelf EmployedUnemployedWhat is your part-time occupation? Your DrivingWhat type of driving licence do you hold?(Required)Please Select an ItemUK Full licenceProvisional (UK) licenceFull UK licence – Automatic vehicles onlyFull EU licenceFull International licenceOtherWhen did you obtain your licence?(Required) DD dash MM dash YYYY Do you have any medical conditions that affect your driving?(Required) Yes No Have you notified the DVLA of your medical condition?(Required) Yes No Have you ever been refused car insurance, or ever had an insurance policy voided or cancelled?(Required) Yes No Claims and ConvictionsHave you had any accidents, claims or losses in the past 5 years, regardless of blame?(Required) Yes No When was the claim made?(Required) DD dash MM dash YYYY Claim description(Required) Was the No Claims Discount affected?(Required)YesNoCosts of repairs to the insured vehicle(Required)Cost of third party repairs(Required)Was there any personal injury?(Required)YesNoDo you have any Convictions in the past 5 years?(Required) Yes No Date of conviction(Required) DD dash MM dash YYYY Conviction type / code(Required) How many points received? (enter 0 if none)(Required)How much was the fine? (if applicable) (enter 0 if none)(Required)Was the driver banned? (if applicable)(Required)First ChoiceSecond ChoiceThird ChoiceHow many months was this for? (if applicable)(Required) Have you been convicted of any non-motoring offence(s)?(Required) Yes No
