Quote Form - Forces Solutions

Personal Details

Title

Your Forename(s)

Your Surname

Telephone Number

Email Address

Vehicle Registration

Date Of Birth We need your date of birth to calculate your age. This is required for the insurance quote. Please note that you need to be aged between 20-75 to be able to get a quote online.

Martial Status

Address BFPO

Full Time

Type Of Employment

Occupation Don’t worry if you can’t find your exact occupation. Insurers use a standard occupation list so select the closest match. Forces personnel try finding your specific role, for example “Clerk”, “Engineer”, “Nurse”, “Teacher”, “Police Officer”. If you can’t find it you can enter “Army”, “Navy”, “Royal Marine” or “Air Force”.

Nature Of Business If the business type is not listed, select another business type that is the closest fit. If you are serving or are attached to the Forces, please use HM Forces. If you are a civil servant attached to the Forces please select Goverment - UK. If you are visiting Forces please select Goverment - Foreign.

Secondary Occupation

Secondary Nature Of Business

Licence Type

Do you have an HGV Licence?

Any licence restrictions? YesNo [group pdLicencegroup clear_on_hide] [/group]

Any additional driving qualifications? YesNo [group pdADQualificationsgroup clear_on_hide] [/group]

Country Of Issue

Driving licence held since

Do you hold a CAT C Licence? If you hold a Cat C or Cat C+E we can provide you with a professional Drivers discount. Please note if you passed your test prior to 1999 you may have Cat C on your licence which was "Grandfather rights" unfortuntaley we can't provide a discount for us YesNo

Any Policies Cancelled or Voided? Failure to disclose any material facts by any driver may lead to your policy being cancelled, declined or voided. Your insurance company will have advised if any special terms have ever been imposed on your policy. YesNo

Any Special Terms Imposed? Failure to disclose any material facts by any driver may lead to your policy being cancelled, declined or voided. Your insurance company will have advised if any special terms have ever been imposed on your policy. YesNo

Any Restricted Terms Applied? Failure to disclose any material facts by any driver may lead to your policy being cancelled, declined or voided. Your insurance company will have advised if any special terms have ever been imposed on your policy. YesNo

Has the driver any pending prosecutions or convictions for non motoring offences? After a specified period of time some criminal convictions are considered spent and no longer need to be disclosed to your insurer. If you have a criminal conviction, which is unspent, please let us know. YesNo

[cf7mls_step cf7mls_step-1 "Proceed To Additional Drivers" ""]

Additional Drivers

Add An Additional Driver? YesNo [group FirstAdditionalDriverDetails clear_on_hide]

First Additional Driver Details

Title

Your Forename(s)

Your Surname

Date Of Birth We need your date of birth to calculate your age. This is required for the insurance quote. Please note that you need to be aged between 20-75 to be able to get a quote online.

Martial Status

Relationship to Proposer

Full Time

Type Of Employment

Occupation

Nature Of Business

Secondary Occupation

Secondary Nature Of Business

Licence Type

Do you have an HGV Licence?

Country Of Issue

Issue Date

Any licence restrictions? YesNo [group DriverFirstLicencegroup clear_on_hide] [/group]

Any additional driving qualifications? YesNo [group DriverFirstADQualificationsgroup clear_on_hide] [/group]

Add A Second Additional Driver? YesNo [/group] [group SecondAdditionalDriverDetails clear_on_hide]

Second Additional Driver Details

Title

Your Forename(s)

Your Surname

Date Of Birth We need your date of birth to calculate your age. This is required for the insurance quote. Please note that you need to be aged between 20-75 to be able to get a quote online.

Martial Status

Relationship to Proposer

Full Time

Type Of Employment

Occupation

Nature Of Business

Secondary Occupation

Secondary Nature Of Business

Licence Type

Do you have an HGV Licence?

Country Of Issue

Issue Date

Any licence restrictions? YesNo [group DriverSecondLicencegroup clear_on_hide] [/group]

Any additional driving qualifications? YesNo [group DriverSecondADQualificationsgroup clear_on_hide] [/group]

Add A Third Additional Driver? YesNo [/group] [group ThirdAdditionalDriverDetails clear_on_hide]

Third Additional Driver Details

Title

Your Forename(s)

Your Surname

Date Of Birth We need your date of birth to calculate your age. This is required for the insurance quote. Please note that you need to be aged between 20-75 to be able to get a quote online.

Martial Status

Relationship to Proposer

Full Time

Type Of Employment

Occupation

Nature Of Business

Secondary Occupation

Secondary Nature Of Business

Licence Type

Do you have an HGV Licence?

Country Of Issue

Issue Date

Any licence restrictions? YesNo [group DriverThirdLicencegroup clear_on_hide] [/group]

Any additional driving qualifications? YesNo [group DriverThirdADQualificationsgroup clear_on_hide] [/group]

Add A Fourth Additional Driver? YesNo [/group] [group FourthAdditionalDriverDetails clear_on_hide]

Fourth Additional Driver Details

Title

Your Forename(s)

Your Surname

Date Of Birth We need your date of birth to calculate your age. This is required for the insurance quote. Please note that you need to be aged between 20-75 to be able to get a quote online.

Martial Status

Relationship to Proposer

Full Time

Type Of Employment

Occupation

Nature Of Business

Secondary Occupation

Secondary Nature Of Business

Licence Type

Do you have an HGV Licence?

Country Of Issue

Issue Date

Any licence restrictions? YesNo [group DriverFourthLicencegroup clear_on_hide] [/group]

Any additional driving qualifications? YesNo [group DriverFourthADQualificationsgroup clear_on_hide] [/group]

Add A Fifth Additional Driver? YesNo [/group] [group FifthAdditionalDriverDetails clear_on_hide]

Fifth Additional Driver Details

Title

Your Forename(s)

Your Surname

Date Of Birth We need your date of birth to calculate your age. This is required for the insurance quote. Please note that you need to be aged between 20-75 to be able to get a quote online.

Martial Status

Relationship to Proposer

Full Time

Type Of Employment

Occupation

Nature Of Business

Secondary Occupation

Secondary Nature Of Business

Licence Type

Do you have an HGV Licence?

Country Of Issue

Issue Date

Any licence restrictions? YesNo [group DriverFifthLicencegroup clear_on_hide] [/group]

Any additional driving qualifications? YesNo [group DriverFifthADQualificationsgroup clear_on_hide] [/group]

Add A Sixth Additional Driver? YesNo [/group] [group SixthAdditionalDriver clear_on_hide] Please Contact +44(0) 116 473 5473 For Additional Drivers [/group][cf7mls_step cf7mls_step-2 "Back To Personal Details" "Proceed To Claims" "Step 3"]

Additional Claims

Has the driver had any motor accidents, loses or claims in the past 5 years, regardless of blame? It is really important to tell us about any claims (including unsettled claims), accidents or losses as this may impact your policy. YesNo [group FirstAdditionalClaim]

First Claim

Please select the driver involved in the incident

When did the incident occur?

Incident Type Accident - This will include incidents where you weren't in the car at the time. Theft - Theft or attempted theft of items within your car or of the actual car itself. Fire - Fire damage caused to your car. Malicious damage - Damage caused to your car which was caused by anything other than another car. Riot - Damage caused to your car due to a riot. Storm - Damage caused to your car as a result of adversed weather or floods. Windscreen - If you have had to replace the windscreen on your car.

Were any other vehicles involved in the accident?

Did the incident result in a claim being made against this driver's insurance policy?

Were there any injuries?

Were you at Fault?

Was your No Claims Bonus Affected? Your NCB (no claims bonus) can be affected if the claim reduced the number of years you had previously accumulated. Your current insurance provider will tell you how many years of NCD you have and whether it was affected as a result of the claim.

Description of the Incident

Would you like to add an additional claim? YesNo

[/group] [group SecondAdditionalClaim]

Second Additional Claim

Please select the driver involved in the incident

When did the incident occur?

Were any other vehicles involved in the accident?

Did the incident result in a claim being made against this driver's insurance policy?

Were there any injuries?

Were you at Fault?

Description of the Incident

Would you like to add an additional claim? YesNo

[/group] [group ThirdAdditionalClaim]

Third Additional Claim

Please select the driver involved in the incident

When did the incident occur?

Were any other vehicles involved in the accident?

Did the incident result in a claim being made against this driver's insurance policy?

Were there any injuries?

Were you at Fault?

Description of the Incident

Would you like to add an additional claim? YesNo

[/group] [group SixthAdditionalClaim clear_on_hide] Please Contact +44(0) 116 473 5473 For Additional Claims [/group][cf7mls_step cf7mls_step-3 "Back To Additional Drivers" "Proceed To Motor Convictions" "Step 4"]

Additional Motor Convictions

Have you had any driving related convictions, endorsements, penalties, disqualifications or bans in the past 5 years? Please add details, of any pending prosecutions, convictions, endorsements, penalties, disqualifications or bans for motoring offences. Include any convictions that are pending or considered expired for the purpose of the provisions of the Totting-Up procedure but are otherwise not considered expired or spent. YesNo [group FirstAdditionalConviction clear_on_hide]

First Motor Conviction

Please select the driver who has had the conviction?

Please advise the offence date Your conviction details covering the last four years can be found by visiting www.gov.uk/view-driving-licence. Please note that we require you to declare up to five years driving history.

Please advise of the conviction date

Please select the conviction code that was endorsed on your licence

Country of offence

Did the offence result in penalty points?

Did the offence result in a fine?

Number of penalty points imposed

Amount of fine imposed

Did the offence result in a ban from driving?

Number of months ban imposed

Would you like to add an additional conviction? YesNo [/group] [group SecondAdditionalConviction clear_on_hide]

Second Additional Motor Conviction

Please select the driver who has had the conviction?

Please advise of the conviction date

Please select the conviction code that was endorsed on your licence

Country of offence

Did the offence result in penalty points?

Did the offence result in a fine?

Number of penalty points imposed

Amount of fine imposed

Did the offence result in a ban from driving?

Number of months ban imposed

Would you like to add an additional conviction? YesNo [/group] [group ThirdAdditionalConviction clear_on_hide]

Third Additional Motor Conviction

Please select the driver who has had the conviction?

Please advise of the conviction date

Please select the conviction code that was endorsed on your licence

Country of offence

Did the offence result in penalty points?

Did the offence result in a fine?

Number of penalty points imposed

Amount of fine imposed

Did the offence result in a ban from driving?

Number of months ban imposed

Would you like to add an additional conviction? YesNo [/group] [group FourthAdditionalConviction clear_on_hide]

Fourth Additional Motor Conviction

Please select the driver who has had the conviction?

Please advise of the conviction date

Please select the conviction code that was endorsed on your licence

Country of offence

Did the offence result in penalty points?

Did the offence result in a fine?

Number of penalty points imposed

Amount of fine imposed

Did the offence result in a ban from driving?

Number of months ban imposed

Would you like to add an additional conviction? YesNo [/group] [group FifthAdditionalConviction clear_on_hide]

Fifth Additional Motor Conviction

Please select the driver who has had the conviction?

Please advise of the conviction date

Please select the conviction code that was endorsed on your licence

Country of offence

Did the offence result in penalty points?

Did the offence result in a fine?

Number of penalty points imposed

Amount of fine imposed

Did the offence result in a ban from driving?

Number of months ban imposed

Would you like to add an additional conviction? YesNo [/group] [group SixthAdditionalConviction clear_on_hide] Please Contact +44(0) 116 473 5473 For Additional Convictions [/group][cf7mls_step cf7mls_step-4 "Back To Claims" "Proceed To Medical" "Step 5"]

Additional Medical Conditions

Has the driver any medical condition of which the DVLA should be advised? The list of conditions that need to be advised to the DVLA can be found here https://www.gov.uk/health-conditions-and-driving. YesNo

[group FirstAdditionalMedicalCondition clear_on_hide]

First Medical Condition

Please select the driver who has had the medical condition?

Please confirm the DVLA has been advised of all such conditions YesNo

Would you like to add an additional Medical condition? YesNo [/group]

[group SecondAdditionalMedicalCondition clear_on_hide]

Second Medical Condition

Please select the driver who has had the medical condition?

Please confirm the DVLA has been advised of all such conditions YesNo

Would you like to add an additional Medical condition? YesNo [/group]

[group ThirdAdditionalMedicalCondition clear_on_hide]

Third Medical Condition

Please select the driver who has had the medical condition?

Please confirm the DVLA has been advised of all such conditions YesNo

Would you like to add an additional Medical condition? YesNo [/group]

[group FourthAdditionalMedicalCondition clear_on_hide]

Fourth Medical Condition

Please select the driver who has had the medical condition?

Please confirm the DVLA has been advised of all such conditions YesNo

Would you like to add an additional Medical condition? YesNo [/group]

[group FifthAdditionalMedicalCondition clear_on_hide]

Fifth Medical Condition

Please select the driver who has had the medical condition?

Please confirm the DVLA has been advised of all such conditions YesNo

Would you like to add an additional Medical condition? YesNo [/group] [group SixthAdditionalMedicalCondition clear_on_hide] Please Contact +44(0) 116 473 5473 For Additional Medical Conditions [/group][cf7mls_step cf7mls_step-5 "Back To Convictions" "Proceed To Vehicle" "Step 6"]

Vehicle

Make

Model

Capacity

Year Of Make

Value

Does the car have a factory fitted alarm/immobiliser?

Does the car have a tracking device fitted?

Fuel

Transmission

Doors

Annual Mileage This is the total number miles you expect this car to be driven over the next year on the policy. It is important that this is as accurate as possible, as underestimating the mileage could impact your cover or lead to increased charges.

Date Of Purchase You can find the ‘acquired vehicle on’ date in section 5 of the V5C registration document (log book).

Parked Overnight If you leave the car in different places overnight, please choose the one in which the car is most often kept.

RHD/LHD Please select whether your can is Right-hand-driver or Left-hand-drive Right hand drive is the UK standard. This means that when you are sat in your car facing the windscreen, the steering wheel is on the right side.

Vehicle Owner

Registered Keeper

Modifications A car is considered modified if it has been changed in any way since it was first made by the car manufacturer. This would include: changes to the body work including bodykit, suspension or brakes, cosmetic changes and changes to the engine management system or exhaust system. If you are unsure whether changes to the vehicle are classed as a modification, please add them on and we will be able to check with the insurer. Adapted For DisabilityAir FilterAlloy WheelsBody Coloured BumpersBody KitBull BarsDecals/StickersEngine Chip 0-10% Increase in BHPEngine Chip 11 - 25% Increase in BHPExhaust System ChangesExhaust System Changes - CosmeticInduction Kit (Non-Turbo)Induction Kit (Turbo Vehicle)Interior ChangesLPG ConversionNon-standard Re-sprayRally LightsReplacement SeatsSide Skirts/SillsSide StepsSpot LightsStandard Engine ReplacementStripesStruct BraceTinted WindowsTowbarTransmission ChangesUpholstery ChangesUprated BrakesUprated Headlight BulbsVinyl Wrap BodyworkWheel SpacersWheel TrimsWider TyresWider Wheels

Cover Options

Cover

Drivers

Number of No Claims Bonus The 'no claims bonus' an insurer gives each year you are insured without making a claim. The number enetered here should reflect the bonus you will have when the policy starts. If the vehicle is currently insured and that insurance policy is due for renewal, the renewal notification from the current insurer will confirm the bonus earnt. If you have made a claim or been in an incident in the last year, or since the renewal notification arrived, please check how many years bonus the current insurer will issue. The no claims bonus earned can only be used on one vehicel at a time.

Protected

Inception Date

Region where no claims bonus earned

Any Additional Info

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Personal Details

Additional Drivers

First Additional Driver Details

Second Additional Driver Details

Third Additional Driver Details

Fourth Additional Driver Details

Fifth Additional Driver Details

Additional Claims

First Claim

Second Additional Claim

Third Additional Claim

Additional Motor Convictions

First Motor Conviction

Second Additional Motor Conviction

Third Additional Motor Conviction

Fourth Additional Motor Conviction

Fifth Additional Motor Conviction

Additional Medical Conditions

First Medical Condition

Second Medical Condition

Third Medical Condition

Fourth Medical Condition

Fifth Medical Condition

Vehicle

Cover Options

Who we are

Useful links