Bus and Coach Insurance

Motor Quote

Step 1 of 5...

Contact Name :
Company Name :
Address :
Tel Number :
Email Address :
Renewal date :
Current Broker :
Current insurer :
Other insurances required : Liability Premises Recovery H&S

Step 2 of 5...

How long have you been trading for (years)? :
Type of work : Private Hire Stage Carriage Express Shuttle School Contracts Airports Charities
Foreign Work (no. of days)? :
Other (please specify) :
Please tell us a bit about you &/or your company: :

Step 3 of 5...

Vehicle 1 : Reg No :
Vehicle 1 : Make & Model :
Vehicle 1 : No. of Seats (inc driver) :
Vehicle 1 : Year of Make :
Cover :
Vehicle 1 : No. Claims Bonus :
Vehicle 2 : Reg No :
Vehicle 2 : Make & Model :
Vehicle 2 : No. of Seats (inc driver) :
Vehicle 2 : Year of Make :
Cover :
Vehicle 2 : No. Claims Bonus :
Vehicle 3 : Reg No :
Vehicle 3 : Make & Model :
Vehicle 3 : No. of Seats (inc driver) :
Vehicle 3 : Year of Make :
Cover :
Vehicle 3 : No. Claims Bonus :
Vehicle 4 : Reg No :
Vehicle 4 : Make & Model :
Vehicle 4 : No. of Seats (inc driver) :
Vehicle 4 : Year of Make :
Cover :
Vehicle 4 : No. Claims Bonus :

Step 4 of 5...

Who would you like to driver your vehicle? : Insured only insured + 1 named driver Any authorised driver (subject to terms)
Are any of your drivers under 25 or over 65 ? :
Do any of your drivers have less than 2 years relevant licence experience? :
Have you or any driver been convicted of any motoring offence which is still in force? :
Have you or any driver had any accidents, losses or claims during the past 3 years? :
Have you or any driver got any medical conditions which are reportable to the DVLA? :
Ever been declined insurance, or had any special terms imposed, or a motor policy cancelled? :

If you have answed yes to any of the above questions please provide details below:

Driver 1 : (Driver Name, DOB, Details (including conviction code & date where applicable / accident circumstances & date) :
Driver 2 : (Driver Name, DOB, Details (including conviction code & date where applicable / accident circumstances & date) :
Driver 3 : (Driver Name, DOB, Details (including conviction code & date where applicable / accident circumstances & date) :
Driver 4 : (Driver Name, DOB, Details (including conviction code & date where applicable / accident circumstances & date) :

Please provide details of all losses or claims in the past three years (fault and non fault):

Date, Driver, Description, Costs (your vehicle) / (third party) :
Additional Information :

Declaration:
I / we declare that to the best of my / our knowledge

a) the above statement and particulars, whether written by me / us or by others on my / our behalf are true and complete
b) I / we have not withheld any material facts *

* material facts are those facts which are likely to influence us in the acceptance or assessment of this proposal and it is essential that you disclose them. If you are in doubt about whether a fact is material, you should disclose it, since failure to do so could invalidate your policy.