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Motor Fleet Insurance Quotation

Motor Fleet Insurance Quotation Form

If you have any questions or would prefer to speak directly with one of our Motor Fleet Insurance Advisors, please call us on 01962 774421.

GENERAL DETAILS
Your Name*
First Last
Company Name
What is your Company type?*
How many years have you been trading in this business?
Phone Number*
Alternate Phone Number
Correspondence Address*
Address Line 1* Address Line 2 Town or City* County* Postcode* Country
Email Address*
Alternate Email Address
When do you need the insurance to start from?
Leave blank for ASAP
DD slash MM slash YYYY
Vehicle Details
Please indicate the total number of vehicles in your fleet?
Please complete the vehicle details below;
To add another vehicle, please press the plus button to the right of the columns.
Year Make Model Registration Current Market Value Overnight Postal Code
What cover do you require?
What driver age restrictions do you require?
We are able to look at pricing options for different age restrictions.
Have any of your drivers had any motoring offenses in the past 5 years?
- Yes
- No
Please provide details of the driver and the motoring offence incurred.
To add another driver and offense, please press the plus button to the right of the columns.
Driver Name What was the Offence Date of Offence
Are all vehicles owned or leased by the company?
- Yes
- No
Please provide details of the vehicles, their owners and their relationship to you/the company.
Will you require cover for driving in Europe?
- Yes
- No
Will your vehicles visit any hazardous sites?
For example power stations, nuclear installations, refineries, any airports, rail trackside, gas or chemical industries, Ministry of Defence Premises
- Yes
- No
Please provide details of where the vehicles visit and frequency.
Will your vehicle be carrying any gas bottles?
- Yes
- No
How many vehicles will be carrying gas bottles?
What type of gasses do you carry?
Will any of your vehicles be carrying any fuel?
- Yes
- No
How many vehicles will be carrying fuel?
What type of fuel do you carry?
What is the maximum number of canisters carried in any one vehicle at any one time?
How is the fuel secured in the vehicle?
Do you have a confirmed claims experience?
- Yes
- No
Do you hire in temporary additional vehicles?
- Yes
- No
Please estimate the number of temporary vehicles that may be used across the year?
Additional Cover
Is Motor Legal Expenses required?
Is Breakdown Cover required?
CLAIMS AND OTHER INFORMATION
Has the Proposed Policyholder (s) ever had any claims or incidents?
- Yes
- No
Please provide further information about the claim/incident
Has the Proposed Policyholder (s) ever had any criminal convictions?
- Yes
- No
Please give details of conviction(s)
Has the Proposed Policyholder (s) ever had any insurance declined, cancelled or any special terms imposed?
- Yes
- No
Please provide further details of why insurance was declined, cancelled or why special terms were imposed:
Please detail any other information which you feel might be relevant.
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CoverMarque Ltd is authorised and regulated by the Financial Conduct Authority FRN: 310705 - Registered Office: The Boundary, Coxford Down, Winchester, Hampshire, SO21 3BD; Company Registration Number: 04806646 - Managing Director: Nick Drew B.A. Hons (Dunelm) - Company Secretary: Professor Bridget Drew OBE BSC PHD C.Biol F.I.Biol F.R.A.g.s.

Motor Fleet Insurance Quotation

Motor Fleet Insurance Quotation Form

GENERAL DETAILS

Vehicle Details

Additional Cover

CLAIMS AND OTHER INFORMATION

Covermarque Limited

Contact Details

Year	Make	Model	Registration	Current Market Value	Overnight Postal Code

Driver Name	What was the Offence	Date of Offence