Agricultural
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Same Day Quick Quote Form...
Target Premium
Date Cover Required
Broker Details...
Broker
Branch
Postcode
Telephone
Facsimile
Email
Contact
Quote Details...
Client
Company
Street No.
Postcode
Occupation
Existing Client?
Yes
No
Contractor?
Yes
No
If yes:
Spraying?
Yes
No
Annual Mileage...
Own Purposes Only?
Yes
No
If no:
Over 50KM?
Yes
No
Voluntary Excess...
Amount Required
Vehicle One...
Type
Type 1
Type 2
Type 3
Type 4
Type 5
Type 1
Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2
Forestry Vehicles
Type 3
Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4
Specified Trailers, Trailed Mowers etc.
Type 5
All Terrain Vehicles / Quad Bikes
Cover Required
Vehicle Age
Vehicle Reg
Make
Model
CC
(Type 5 Only)
Value
Vehicle Two...
Type
Type 1
Type 2
Type 3
Type 4
Type 5
Type 1
Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2
Forestry Vehicles
Type 3
Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4
Specified Trailers, Trailed Mowers etc.
Type 5
All Terrain Vehicles / Quad Bikes
Cover Required
Vehicle Age
Vehicle Reg
Make
Model
CC
(Type 5 Only)
Value
Vehicle Three...
Type
Type 1
Type 2
Type 3
Type 4
Type 5
Type 1
Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2
Forestry Vehicles
Type 3
Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4
Specified Trailers, Trailed Mowers etc.
Type 5
All Terrain Vehicles / Quad Bikes
Cover Required
Vehicle Age
Vehicle Reg
Make
Model
CC
(Type 5 Only)
Value
Vehicle Four...
Type
Type 1
Type 2
Type 3
Type 4
Type 5
Type 1
Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2
Forestry Vehicles
Type 3
Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4
Specified Trailers, Trailed Mowers etc.
Type 5
All Terrain Vehicles / Quad Bikes
Cover Required
Vehicle Age
Vehicle Reg
Make
Model
CC
(Type 5 Only)
Value
Vehicle Five...
Type
Type 1
Type 2
Type 3
Type 4
Type 5
Type 1
Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2
Forestry Vehicles
Type 3
Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4
Specified Trailers, Trailed Mowers etc.
Type 5
All Terrain Vehicles / Quad Bikes
Cover Required
Vehicle Age
Vehicle Reg
Make
Model
CC
(Type 5 Only)
Value
Vehicle Six...
Type
Type 1
Type 2
Type 3
Type 4
Type 5
Type 1
Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2
Forestry Vehicles
Type 3
Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4
Specified Trailers, Trailed Mowers etc.
Type 5
All Terrain Vehicles / Quad Bikes
Cover Required
Vehicle Age
Vehicle Reg
Make
Model
CC
(Type 5 Only)
Value
Vehicle Seven...
Type
Type 1
Type 2
Type 3
Type 4
Type 5
Type 1
Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2
Forestry Vehicles
Type 3
Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4
Specified Trailers, Trailed Mowers etc.
Type 5
All Terrain Vehicles / Quad Bikes
Cover Required
Vehicle Age
Vehicle Reg
Make
Model
CC
(Type 5 Only)
Value
Vehicle Eight...
Type
Type 1
Type 2
Type 3
Type 4
Type 5
Type 1
Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2
Forestry Vehicles
Type 3
Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4
Specified Trailers, Trailed Mowers etc.
Type 5
All Terrain Vehicles / Quad Bikes
Cover Required
Vehicle Age
Vehicle Reg
Make
Model
CC
(Type 5 Only)
Value
Vehicle Nine...
Type
Type 1
Type 2
Type 3
Type 4
Type 5
Type 1
Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2
Forestry Vehicles
Type 3
Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4
Specified Trailers, Trailed Mowers etc.
Type 5
All Terrain Vehicles / Quad Bikes
Cover Required
Vehicle Age
Vehicle Reg
Make
Model
CC
(Type 5 Only)
Value
Vehicle Ten...
Type
Type 1
Type 2
Type 3
Type 4
Type 5
Type 1
Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2
Forestry Vehicles
Type 3
Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4
Specified Trailers, Trailed Mowers etc.
Type 5
All Terrain Vehicles / Quad Bikes
Cover Required
Vehicle Age
Vehicle Reg
Make
Model
CC
(Type 5 Only)
Value
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Comp
u
Quote
is a trading name of
Bollington Underwriting Ltd
| Unit 26, Hampstead Avenue, Mildenhall, Suffolk IP28 7AS
