Please take care to answer all the questions honestly and to the best of your knowledge. Failure to do so could effect your level of cover, amount payable, your policy cancelled or any claims that you make rejected.
Your Personal Details
Please enter the date in the format DD/MM/YYYY, e.g. 21/01/1975.
Contact Information
Please remember to include your STD area dialling code, e.g. 0207
For landlines, please remember to include your STD area dialling code, e.g. 0207
This email address may be used to contact you about this quote.
Employment Information
Please enter your job description.
This will generate a list from which you can select the most appropriate description.
For example: If you work in a call centre, you should enter Telesales Person or Customer Advisor.
NB: If you have entered only part of your job description and you are unable to find your job in the list, please enter more characters to refine the list.
Please enter a description of your employer's general area of business.
This will generate a list from which you can select the most appropriate description.
For example: If you work in a high street shop, you should enter Retailing.
NB: If you have entered only part of your employer's business and you are unable to find the correct business in the list, please enter more characters to refine the list.
Please enter a description of your general area of business.
This will generate a list from which you can select the most appropriate description.
For example: If you work in a high street shop, you should enter Retailing.
NB: If you have entered only part of your business and you are unable to find the correct business in the list, please enter more characters to refine the list.
Please enter a description of your general area of business.
This will generate a list from which you can select the most appropriate description.
For example: If you work in a high street shop, you should enter Retailing.
NB: If you have entered only part of your business and you are unable to find the correct business in the list, please enter more characters to refine the list.
Part-time Employment Information
Please enter your part-time job description. This will generate a list from which you can select the most appropriate description.
For example: If you work in a call centre, you should enter Telesales Person or Customer Advisor.
NB: If you have entered only part of your job description and you are unable to find your job in the list, please enter more characters to refine the list.
Please enter a description of your part-time employer's general area of business. This will generate a list from which you can select the most appropriate description.
For example: If you work in a high street shop, you should enter Retailing.
NB: If you have entered only part of your employer's business and you are unable to find the correct business in the list, please enter more characters to refine the list.
Please enter a description of your part-time general area of business. This will generate a list from which you can select the most appropriate description.
For example: If you work in a high street shop, you should enter Retailing.
NB: If you have entered only part of your business and you are unable to find the correct business in the list, please enter more characters to refine the list.
Please enter a description of your part-time general area of business. This will generate a list from which you can select the most appropriate description.
For example: If you work in a high street shop, you should enter Retailing.
NB: If you have entered only part of your business and you are unable to find the correct business in the list, please enter more characters to refine the list.
Your Driving
Telling DVLA about a medical condition or disability
You must tell DVLA if you have a driving licence and:
- you develop a ‘notifiable’ medical condition or disability
- a condition or disability has got worse since you got your licence
Notifiable conditions are anything that could affect your ability to drive safely. They can include:
- epilepsy
- strokes
- other neurological and mental health conditions
- physical disabilities
- visual impairments
You could be fined up to £1,000 if you don’t tell DVLA about a condition that might affect your ability to drive safely. You could also be prosecuted if you have an accident.
By phone
DVLA drivers’ medical enquiries
Telephone: 0300 790 6806
Monday to Friday, 8am to 5:30pm
Saturday, 8am to 1pm
Claims and Convictions
-
Was the No Claims Discount affected?
If you are held liable for a claim, your No Claims Discount could be affected.
Examples include:
• You are held responsible for an accident
• Your car is stolen
• Your car is hit by an uninsured or hit-and-run driver
Cost of repairs to the insured vehicle:
Please enter the cost of the repairs to your car. If you are unsure of this, please provide an estimate. If there were none, please enter 0.
Cost of third party repairs:
Please enter any third party costs. If you are unsure of this, please provide an estimate. If there were none, please enter 0.
-
Conviction Type / Code:
This is the conviction code as it appears on the driver's driving licence, e.g. SP30
Level of reading taken:
If the alcohol reading was taken from:
Breath: Please enter the micrograms of alcohol per 100 millilitres of breath. The legal limit is 35µg
Blood: Please enter the milligrams of alcohol per 100 millilitres of blood. The legal limit is 80mg
Urine: Please enter the milligrams of alcohol per 100 millilitres of urine. The legal limit is 107mg
Additional Drivers
Additional Driver 1 Details
- "Who will be insured to drive the vehicle?" has been set to "Policy Holder and Spouse". Additional driver must be Married
- "Who will be insured to drive the vehicle?" has been set to "Policy Holder and Spouse". Additional driver must be Spouse of Policy Holder.
Telling DVLA about a medical condition or disability
You must tell DVLA if you have a driving licence and:
- you develop a ‘notifiable’ medical condition or disability
- a condition or disability has got worse since you got your licence
Notifiable conditions are anything that could affect your ability to drive safely. They can include:
- epilepsy
- strokes
- other neurological and mental health conditions
- physical disabilities
- visual impairments
You could be fined up to £1,000 if you don’t tell DVLA about a condition that might affect your ability to drive safely. You could also be prosecuted if you have an accident.
By phone
DVLA drivers’ medical enquiries
Telephone: 0300 790 6806
Monday to Friday, 8am to 5:30pm
Saturday, 8am to 1pm
Please enter your job description.
This will generate a list from which you can select the most appropriate description.
For example: If you work in a call centre, you should enter Telesales Person or Customer Advisor.
NB: If you have entered only part of your job description and you are unable to find your job in the list, please enter more characters to refine the list.
Please enter a description of their employer's general area of business.
This will generate a list from which you can select the most appropriate description.
For example: If they work in a high street shop, you should enter Retailing.
NB: If you have entered only part of their employer's business and you are unable to find the correct business in the list, please enter more characters to refine the list.
Please enter a description of their general area of business.
This will generate a list from which you can select the most appropriate description.
For example: If they work in a high street shop, you should enter Retailing.
NB: If you have entered only part of their business and you are unable to find the correct business in the list, please enter more characters to refine the list.
Please enter a description of their general area of business.
This will generate a list from which you can select the most appropriate description.
For example: If they work in a high street shop, you should enter Retailing.
NB: If you have entered only part of their business and you are unable to find the correct business in the list, please enter more characters to refine the list.