Corporate Clients

Please complete all of the following fields.
**Denotes compulsory field

Name of Business **

Contact Name **

Contact Number **

Email **

Preferred contact method

Please select Phone Email

Are you a new or existing client?

Please select New Existing

If new, please advise how you got our name

Please select Websearch Recommendation Advertising Other

If existing, please enter your Client Reference if known

Do you currently have Motor Trade insurance for this business?

Please select Yes No

If yes, what is the renewal date?

D: M: Y:

What is the current annual premium that you pay?

When was the business established (year)?

Premises Address

Trade (e.g. Bodywork, Mechanical, MOTs)

No. of Employees

Estimated Annual Turnover

Number of items requiring engineering inspection (if applicable)

Do you wish to cover company vehicles under this policy

Please select Yes No

Wage roll - clerical staff (including directors)

Wage roll - manual staff

Current Annual Turnover

Number of vehicles to be insured

Who do you want to be insured to drive the vehicles?

Please select Named Drivers (max 5) Any Driver under 25 Any Driver over 25

Vehicle use

Please select Social, Domestic and Pleasure Business Use

What type of cover do you require on the vehicles?

Please select Comprehensive Third Party Fire & Theft Third Party Only

Public Liability limit of indemnity

Please select £1m £2m £3m £5m £10m

Own vehicles - Total sum insured

Customer vehicles - Total sum insured

Parts / Stock

Tools

Plant and Machinery

Business Interruption Cover

Business Interruption Cover - is cover required over 12 or 24 months?

Please select 12 Months 24 Months

Other (please specify)

Have you had any claims under this type of policy in the past 3 years?

Please select Yes No

If yes, please specify the number

Please select 1 2 3 4 5 6 7 8 9 10

Have any of these claims been settled for more than £2,500 (approx)?

Please select Yes No

Please provide any further details relating to your application (e.g. perform MOTs / paint and spray vehicles / ever had request for insurance declined)