Tick Boxs for required covers:
Best Contact Number:
Trading or Business Name:
Date Insurance Required:
Base of Operation:
Radius of Operation:
Do you transport refrigerated goods?
Do you transport Hazardous Goods?
How many consecutive years have you held heavy motor insurance?
Are you the only driver?
If not, how many employed drivers?
List vehicles to be insured:
Years in Business:
Current No Claim Bonus: (if known)
Any Claims last 5 Years?
Do you require a quote for Public Liability?
If Yes, please show approx annual turnover:
If Yes, show year and claims value:
Would you like a Transit Insurance quote?
Basic Cover: Fire, Flood, Collision, Overturning.
Loading / Unloading
Theft, Pilferage, Non delivery
Desciribe the freight you carry, and percentage of each
To what value?
Do you require additional Hazardous Goods clean up cover?
What goods to you carry?
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