Minibus Insurance, Don't call us, we'll call you...

Section 1… Proposer’s details

Name:
Identity:
if “other” please specify:
Nature of organisation:
Address

Town/City:
County:
Postcode:

Section 2... Personal details
(for “private individuals” or “sole traders” only. Otherwise please continue with section 3)

Personal address (if different from above)

Town/City:
County:
Postcode:

Date of birth (DD/MM/YY)
Gender:

Employment status:
Main Occupation:

Is your main occupation in connection with the above detailed in section 1?	Yes No

Section 3… Purpose of use

What will the minibus(es) be used for?

Please also describe the “purpose of use” for the minibus(s): e.g. private hire, church, charity, school runs or trips, Airport, Corporate contracts, etc. If this is a new venture for you, length of private hire or operational experience and if any other vehicles used in connection.



Using your minibus on a courtesy bus basis to transport customers who have purchased goods or services through another part of your commercial business or charging fares to employees, to commute would be deemed as “Hire and reward”. Therefore, you or your organisation would be required to hold the appropriate operators licence.

Section 4… Driver(s) details

If you have more than 3 drivers, please go to section 5

*If you’re a “private individual” please give your personal details under “main driver” and any spouse under “driver 2”.

	*Main Driver	Driver 2	Driver 3
Title:
First Names:
Surname:
Main Occupation:
Employer:
Date of Birth:
Marital status:
Year driver became resident in UK
Type of licence:
How long have they held their licence?

Is “driver 2” a spouse to the “main driver”?		Yes No

Section 5... More than 3 drivers

Please Note

Have you checked whether you or your proposed drivers can legally drive a minibus?

If more than 3 drivers, who else will drive the minibus?

What type(s) of driving license(s) are held by those who will drive your minibus(es)?

PCV D or D1	Full UK car	Provisional	EEC	International
Other; please specify

Have you or any other driver had any accidents or claims in the last five years? No Yes If yes, please provide details:
Drivers Name: Date of claim: Was the driver at fault: Type of claim(i.e. theft, accident, etc.): Cost of claim:£ ----- If there are any other claims please advise details using the same headings as above. Please provide details of any incidents regardless of whether insurance covered you at the time. -----

Have you or any other driver been convicted of any motor offence? No Yes If yes, please provide details:
Drivers Name: Date of conviction: Type of conviction: No. of points: Amount of fine:£ Was there a driving ban: If yes, length of ban: ----- If there are any other convictions please advise details using same the same headings as above.

Do you or any other driver have any disabilities? No Yes If yes, please provide details:
Drivers Name: Type of disability: Have D.V.L.A. been informed: If yes, when advised to D.V.L.A.: Licence restriction: ----- If there are any other drivers with disabilities, please advise details using the same headings as above.

Section 6... Vehicle details

(if more than 3 vehicles, you will be contacted for more details)

Number of vehicles to proposed to be insured?

	vehicle1	vehicle 2	vehicle 3
Type of vehicle:
Make: (i.e. Ford, LDV etc.)
Model: ( i.e. Transit, 400, Ducato etc)
Standard, Conversion or specialist vehicle:
Fuel type:
Vehicle registration:
Number of seats: (including driver)
Are all seats forward facing?	Yes No	Yes No	Yes No
Are seat belts fitted?	Yes No	Yes No	Yes No
Year of registration:
Engine size :
Estimated value:
Estimated annual mileage:
Modifications:	Yes No	Yes No	Yes No
If "yes" Please specify
Has the vehicle been imported or is it left hand drive?	Yes No	Yes No	Yes No
Is the Vehicle plated by the local licensing authority?	Yes No	Yes No	Yes No
Where the vehicle is kept overnight?
*If “Other” please specify
Postcode where vehicle is kept:
Any alarm or security devices fitted?
*If “Other” please specify

Section 7... Cover details

Type of cover required:
Date cover required from:
Number of years No Claims Bonus
Type of policy No claims Bonus earnt on:
Is "No Claims discount" Protection required?	Yes No
Is Voluntary excess required?
Current Insurer:

Section 8... Other details

Any other requirements comments or relevant details? i.e. variations in cover or excess etc.


Best quote so far:	from:	with: excess

Section 9... Contact details

Are you the proposer “personally requiring cover” or are you only responsible for “arranging the insurance policy”

Title
First Name
Surname
Address

Town/City
County
Postcode
Telephone No
E-mail Address

When may we contact you?

...and finally

Please tick box if you agree that the above details given are correct and you have read our terms and conditions.

Please tick box if you wish to receive marketing communications from us, or our nominated insurers, brokers or underwriters by post, telephone, email, text messaging or other electronic means

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