Motor Trade insurance for less!

Title: Mr Mrs Miss Ms Sir Dr

Full Name:

Date of Birth:

Occupation:

email:

Mobile Number:

Daytime Contact Number:

House / Building Number:

Postcode:

Cover Required: Comprehensive Third Party Fire & Theft Third Party Only

Do you require cover for trade premises: Yes No

Are you a full-time Motor Trader: Yes No

Policy Date: 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2011 2012 2013

Indemnity Cover (£): 0 1,000 2,000 5,000 10,000 15,000 20,000 25,000 30,000

Voluntary Excess (£): 0 125 250 500

Have you (or a named driver) had an accident
within the last 5 years: Yes No

Have you (or a named driver) had any driving convictions within the last 5 years: Yes No

Motor Trade No Claims Bonus (Yrs): 0 1 2 3 4 5 6 7 8 9 10+

Car No Claims Bonus (Yrs): 0 1 2 3 4 5 6 7 8 9 10+

Current Premium (£):