Vehicle registration number *
Purchase date * DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / MM 1 2 3 4 5 6 7 8 9 10 11 12 / YYYY 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Estimated annual mileage? * Up to 1000 miles Up to 2000 miles Up to 3000 miles Up to 4000 miles Up to 5000 miles Up to 6000 miles Up to 7000 miles Up to 8000 miles Up to 9000 miles Up to 10000 miles Up to 11000 miles Up to 12000 miles Up to 20000 miles
Price paid for your vehicle *
Are you the registered keeper of the vehicle? * Yes No
Are you the vehicle owner? * Yes No
Where is the car left overnight? * Garaged Secure Public Car Park Shed Carport Street (Away From Home) Unlocked Building Unlocked Compound Unlocked Garage Locked Compound Locked Building Office/Factory Car Park Open Public Car Park Parked On Drive Secure Public Car Park Kept on Private Property Kept on Public Road Kept on 3rd Party Premises Car Park
Does your car have any modifications? (If so, please provide details).
Number of vehicles in the household? * None (0) 1 2 3 4 5 6+
Is the car fitted with an alarm, tracker and/or immobilser? Please select * None Factory Fitted Thatcham Approved Alarm / Immobiliser Factory Fitted Thatcham Approved Alarm Factory Fitted Non-Thatcham Alarm / Immobiliser Factory Fitted Non-Thatcham Alarm Factory Fitted
Type of Cover Required * Fully Comprehensive Third Party Third Party Fire & Theft Learner Driver
Class of Use * Social Only Social & Commuting Business Use Carriage of own goods Carriage of own goods for hire and reward
Additional Driver Full Name
Do they have access to the vehicle? Yes No
Their gender Male Female
Marital Status Single Married Separated Divorced Widowed
Date of birth DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / MM 1 2 3 4 5 6 7 8 9 10 11 12 / YYYY 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Their current job title:
Driving license type Full UK UK Automatic Provisional European License
When did the additional driver obtain their license? DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / MM 1 2 3 4 5 6 7 8 9 10 11 12 / YYYY 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Relationship to Proposer Spouse Parent Sibling Guardian Other (friend, auntie, uncle etc.)
Do they have access to any other Vehicles? No Yes
Do they have any motoring convictions under the road traffic act? No Yes
How many years no claims bonus do they hold? None (0) 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years +
