Fields marked with a * are mandatory
Title :*
Full name :*
Email Address :*
Contact no :*
Mobile no (if different):

Property name/number  (where vehicle is kept) :*
Postcode (where vehicle is kept) :*


Private or Company :
Company name (if applicable):


Proposer Details
Date of birth (DD/MM/YY)
Gender :
Employment status :
Occupation :


Employers business (if applicable):


Why do you use a minibus?

example:large family, business occupation


Who will drive the vehicle?


What type of driving license do you hold?


Have you had any motoring convictions?

If 'yes' please provide the
conviction code and the date
on which the conviction occured.



Have you had any accidents or claims in the
last 3 years?
Date of accident (DD/MM/YY) :
Amount of claim (if known) :
Was the accident you fault?


Vehicle Details
Make and model :
example: Ford Transit
Number of seats :
Are all the seats forward facing and seatbelted?
Year of manufacture :
Engine size :
example: 1600cc
Estimated value :
Vehicle registration :
Estimated annual mileage :
Where is the vehicle kept overnight? :
Current insurer :


Cover and Use
Cover required :
Voluntary excess required :

This will be in addition to the standard policy excess


What will the vehicle be used for? :
How many years no claims discount do you have? :

If you have 4 or more years no claims discount,
would you like to protect it?

When does your present policy expire?
(DD/MM/YY):


Contact time :


How did you hear about us*?
Please tick the box if you prefer not to receive marketing communications from us by post or telephone. 
Please tick the box if you prefer not to receive marketing communications from us by email, text messaging or other electronic means.