Motorhome 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:

Make of vehicle:

Model of vehicle:

Value of Motorhome:

Where is your Motorhome Typically stored overnight: Carport Garaged Locked building Parked on drive Private property Public road Secure compound Other

Who is the Registered Keeper: Policyholder Other

Engine (CC):

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

Have you (or a named driver) had an accident
within the last 5 years: 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

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

Who will drive the vehicle: Insured only Insured +1 named driver Insured +2 named drivers Insured +3 named drivers Insured +4 named drivers Any driver

What type of security if fitted to your Motorhome: No security Factory fitted immobiliser Factory fitted alarm Thatcham immobiliser Thatcham alarm Other

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

Have you or a named driver ever been
refused insurance: Yes No

Current Premium (£):