Motor Trade Road Risks

Quote Form
Proposer’s Details
Proposer’s Name: Home Address:
Trading Name:
Email Address:
Postcode
Telephone Number:

Premises Details
Where does the proposer work from? Home Mobile Premises
Business Address: Type of premises operating from:
Workshop Lockup Forecourt
Showroom Yard Open Site
Postcode
Other (Please specify)
Max capacity of vehicles: MID Allowance: How long at these premises?

Business Details
Date Business Established: Turnover £
Is proposer VAT registered: Yes No VAT number:
Is the occupation full time or part time? Full Time Part Time
If part time, please provide details of any other occupation, including if employed or self employed in
this trade.

How many vehicles handled per year?

Are the driving licenses registered to the home address provided? Yes No
Do you have a utility bill or tenancy agreement in your name at this address? Yes No
Do you keep evidence that you are trading? Yes No

Cover Required
Comprehensive Third party Fire & Theft Third party only

Limit of indemnity own vehicles £

Limit of indemnity customer vehicles £

Excess Required:

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 Motor Trade Occupation
Buying/Selling/Wholesale % Vehicle Deliveries %
Mechanical Repairs % Vehicle Breaker %
Valeting/Steam Cleaning % Tyre & Exhaust Fitters %
Body Repairs % Importing/Exporting %
Breakdown Recovery % Accessory Fitter %
Repossession Agent % Other (Please specify) %

Insurance History
No Claims Bonus Years Earned on MT PC CV
Expiry Date: Previous Insurer:
NCB protection required? Yes No

Drivers
Name
Name DOB Relationship Home Usage Length of Type of Length
to PH Postcode MT/SDP/ABU Residency licence of
licence

1
2
3
4
5

Please provide full details for any drivers that are not full time in the trade.

Has any driver

• Been convicted of ANY motoring offence (other than parking) in the last 5 years or have a prosecution
or enquiry pending? If yes, please provide details in the table on the next page. Yes No

• Had any claims/accidents in the last 5 years?

If yes, please provide details in the table on the next page. Yes No

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 Convictions
Conviction Date Code Fine Amount Points Disqualified Ban Length
(Y/N) (Months)
1
2
3
4
5

Claims
Date Description Total Cost PI claim? Driver’s Fault?
(Y/N) (Y/N)
1
2
3
4
5

Vehicle Details
Reg No. Make Model Value Owned by Postcode
where kept

1
2
3
4
5

Are any of the vehicles leased for a minimum initial period of less than 12 months? Yes No
If yes, please give details.

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 Vehicles to be Driven
Any sports/high performance vehicles Yes No Vehicle Group:
Commercial vehicles over 3.5 tonnes Yes No GVW required:
Motorcycles Yes No cc limit: Max value £
Classic cars over 25 years Yes No
Imports (Please specify) Yes No
Modified vehicles (If yes provide details) Yes No

Horseboxes / Agricultural vehicles / Plant / Machinery Yes No

Rally / Track / Kit cars / Quads / Trikes Yes No
Recovery trucks Yes No
Transporters in excess of 2 vehicles Yes No
American / Canadian Yes No
Motorhomes Yes No
Vehicles with more than 7 seats Yes No
Taxis Yes No

Extensions
Demonstration cover required Yes No
Accompanied /Unaccompanied Comp TPO
Windscreen cover required Yes No
Customer loan vehicles Yes No
If yes, how many? Registration number:
Cover required Comp TPO
Any cover for driving other vehicles required? Yes No
If yes, Comp TPO

Page 4 of 5
 Declaration questions

Have you or anyone who will be insured by this policy?

Had a policy avoided, cancelled, refused or had special terms applied? Yes No

Ever had a claim repudiated or refused? Yes No

Ever had any county court judgement served against you or entered into an individual
voluntary arrangement in the past 5 years? Yes No

Been a director of a company which went into liquidation, receivership, been the subject
of an administration order or declared bankrupt? Yes No

Suffered a disability that has a requirement to contact the DVLA but which has not been
reported to the DVLA, or holds a restricted licence? Yes No

Been convicted of any criminal conviction not spent under the Rehabilitation of Offenders
Act or have any prosecutions pending? Yes No

Been a director or business partner of a business or company other than the motor trade
business proposed here? Yes No

Been involved in vehicle rental, self drive hire, vehicle leasing, vehicle broking or accident
claims management ? Yes No

If yes to any of the questions above, please provide details below:

Additional Information
Please provide any information that you think in essential to the risk.

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