Car Insurance Quote

Vehicle Information

Vehicle registration Have you bought this car yet?

When did you buy / start to lease it?

Month

Year

Estimated value of the car (£) Estimated annual mileage (max 19,000) Security features Has the car been modified?

Insurance Cover Details

When would you like the cover to start? (max 30 days)

Type of Cover: How will the car be used? Where do you keep your car during the day? Is the car kept at your home address overnight? How many vehicles are in the household (including this one)? Do you use any other vehicles? What level of voluntary excess do you need? (max £1000) Preferred payment method How many years No Claims Discount (NCD) do you have? (max 20+) How did you earn your NCD? Do you want to protect your NCD?

Driver Information

Main Driver

Title Date of birth

Relationship status Do any children under 16 live in your household? Do you own your home? Have you lived in the UK continuously since birth? Home postcode House number / name Employment status Do you have a secondary occupation?

Driving licence

Licence type How long have you held this licence? Have you passed any additional driving qualifications?

Declarations

Any medical conditions or disabilities the DVLA must be made aware of? Any unspent non-motoring-related criminal convictions? Any accidents / claims / losses in the last 5 years? Any motoring convictions / endorsements / penalties in the last 5 years? Has any policy ever been declined, cancelled, voided, or special terms imposed?

Would you like to add another driver?

Registered Keeper & Ownership

Are you (the main driver) the registered keeper of the vehicle?

Are you (the main driver) the legal owner of the vehicle?

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