Motor Trade - Road Risk
•
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
NCD
0 Years
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
Maximum Indemnity Limit
Maximum Value Vehicle Stock
Road Risk Excess Amount
£250
£350
£500
£850
£1500
Business trading Area
Sales only
Service only
Sales & service
Recovery & repair
Tyre & exhaust fitter
Windscreen fitter
Recovery only
Valet service
Delivery / Collection service
Salvage
Parking Service
Other
Driver One...
Name
Age
Occupation Code
1: Director - Business, SD&P
2: Partner - Business, SD&P
3: Owner - Business SD&P
4: Employee - Business, SD&P
5: Employee - Business only
6: Social Domestic & Pleasure
7: Business, SD&P and use for second occupation
Convictions (Codes)
Convictions (Dates)
Number of Claims
Claims (Dates)
Driver Two...
Name
Age
Occupation Code
1: Director - Business, SD&P
2: Partner - Business, SD&P
3: Owner - Business SD&P
4: Employee - Business, SD&P
5: Employee - Business only
6: Social Domestic & Pleasure
7: Business, SD&P and use for second occupation
Convictions (Codes)
Convictions (Dates)
Number of Claims
Claims (Dates)
Driver Three...
Name
Age
Occupation Code
1: Director - Business, SD&P
2: Partner - Business, SD&P
3: Owner - Business SD&P
4: Employee - Business, SD&P
5: Employee - Business only
6: Social Domestic & Pleasure
7: Business, SD&P and use for second occupation
Convictions (Codes)
Convictions (Dates)
Number of Claims
Claims (Dates)
Driver Four...
Name
Age
Occupation Code
1: Director - Business, SD&P
2: Partner - Business, SD&P
3: Owner - Business SD&P
4: Employee - Business, SD&P
5: Employee - Business only
6: Social Domestic & Pleasure
7: Business, SD&P and use for second occupation
Convictions (Codes)
Convictions (Dates)
Number of Claims
Claims (Dates)
Driver Five...
Name
Age
Occupation Code
1: Director - Business, SD&P
2: Partner - Business, SD&P
3: Owner - Business SD&P
4: Employee - Business, SD&P
5: Employee - Business only
6: Social Domestic & Pleasure
7: Business, SD&P and use for second occupation
Convictions (Codes)
Convictions (Dates)
Number of Claims
Claims (Dates)
•
Previous Page
Comp
u
Quote
is a trading name of
Bollington Underwriting Ltd
| Unit 26, Hampstead Avenue, Mildenhall, Suffolk IP28 7AS
