Fleet
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Printable Version
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
Existing Client
Yes
No
Type of Business
Years Established
Excess Amount - Min £100
State Type of Cover Required
Comprehensive
Third Party Fire & Theft
Third Party Only
Partners/Directors...
Name
Age
Quote Details...
Use Required (All policies Include Social, Domestic & Pleasure) - Please Tick as Required
SD&P including personal business
Business Purposes excluding Goods
Class 2
Class 3
Business Purposes including the carriage of own Goods
Business Purposes including the carriage of other peoples Goods
Business Purposes - Private Hire
Business Purposes - Public Hire
Where carried, state nature of Goods carried including any Hazardous Goods...
Please answer - Yes or No as applicable...
Will any vehicles be used abroad for Business
Yes
No
Are Drivers permitted to take vehicles home at night
Yes
No
Where are vehicles stored overnight?
Radius Restriction
Under 50 miles from base
Under 100 miles from base
Unlimited
Vehicle Details...
Vehile 1
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 2
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 3
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 4
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 5
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 6
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 7
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 8
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 9
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 10
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 11
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 12
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 13
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 14
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 15
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 16
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 17
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 18
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 19
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Vehile 20
Vehicle Make
Model
C.C. Or G.V.W.
Seating Capacity inc. Driver
Max. Indemnity Value
Registration No:
Driver Details...
Driver Age Band
Any Driver 21-70
Any Driver 25-70
Any Driver 30-70
Give details of any driver with accident, claim or loss within the last 3 years, stating
circumstances and costs including outstanding estimates or attach latest claims experience...
Give details of any driver with a medical condition...
Fleet Management - tick all that apply...
Driver application forms
Driving licence inspected
Vehicle tracking
Safe Driving initiatives
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Comp
u
Quote
is a trading name of
Bollington Underwriting Ltd
| Unit 26, Hampstead Avenue, Mildenhall, Suffolk IP28 7AS
