Please enter the Registration Number * Please enter list of registrations * Has the car been modified, adapted and/or fitted with any optional extras such as changes to the bodywork, engine or wheels? * Owning and using the car Layout When did you purchase the car? Are you (or will you be) the legal owner of this car? * Who is (or will be) the legal owner of the car? Spouse Spouse Civil Partner Common Law Partner Parent Other Leased - Private Leased Company Company Society or Club Are you (or will you be) the registered keeper of this car? * Who is (or will be) the registered keeper of the car? Spouse Spouse Civil Partner Common Law Partner Parent Other Leased - Private Leased Company Company Society or Club What do you use the car for? * Social Only Social Only Social including commuting to a place of work Business Use Where is the car parked during the day? * Where is the car parked overnight? * How many miles does this car cover per year? * Do you drive the car in peak times? What type of fleet do you have? * What vehicles are in your fleet? Your name (the Proposer): * Layout Your title: Mr Mr Mrs Miss Ms Dr (Male) Dr (Female) How long have you lived in the UK? Your marital status: Single Single Married Common Law / Living with Partner Civil Partnered Divorced Seperated Widowed Your main telephone number: * Layout How many children do you have under 16? 0 1 2 3 4 5 6 7 8 9 10+ Your address details Where do you currently live? * Is the car kept at this address overnight? * Layout Total number of cars in the household (including this one): 1 1 2 3 4 5 6 7 8 9 10+ Your occupation What is your occupation status? Employed Employed Self-Employed Full Time Education Job title: Accounting apprentice Accounting apprentice Actor Actor: TV soap Actor: TV comedy Actor: TV comedy Actor: TV soap Actor: TV soap Business administration apprentice School administrator Financial advisor Aerospace engineer Air ambulance doctor Air ambulance pilot Aircraft engineer Alpine ski racer Ambulance dispatcher Trainee business analyst App developer App co-owner (fitness app) A&R (artist & repertoire) Architectural assistant Architect Concept artist Art director Art historian Back of house (Kitchen) assistant Kitchen assistant Assistant learning officer Assistant producer Assistant producer, radio Media assistant Restaurant assistant manage SEO assistant Audio engineer Audiologist Digital engagement apprentice Events assistant Barista Barrister (training) Barrister Beekeeper Biomedical scientist Bird of prey specialist Broadcast assistant Festival build manager Business administration apprentice Business owner: Business development intern Cabin crew Cake designer Camera assistant Camera trainee Cardiac coach Carer Carpentry Catchment officer CEO Chef: Chef and food vlogger Chef de partie Youtube Chemist Chocolatier Dancer and choreographer Civil engineer technician Civil engineering apprentice Cleaner Clinical photographer Rugby coach apprentice Coastguard – maritime operations officer Coder Coding events manager Collections officer Comedian Commissioning and development executive Communications intern Community education coordinator Community cohesion officer Community midwife Composer Conservation apprentice Apprentice conservation officer Conservation officer Conservation trainee Construction manager Construction site engineer Travel consultant Senior content executive Contributor (digital platform) Membership coordinator in a museum Copy editor Coroner's officer Corporate social responsibility coordinator Costume designer for Fantastic Beasts Costume designer for Small Axe Costume standby on Fantastic Beasts Cosmetics creator Junior creative Senior creative Crèche assistant Events curator Customer service team manager Cyber security apprentice Dancer Dance choreographer Data and compliance manager Dental lab assistant Dental nurse Dental nurse assistant Associate development manager Costume designer for Fantastic Beasts Electrical design engineer Handbag designer Jewellery designer Apprentice wing designer Garden designer Graphic designer User experience designer App developer Software developer Business development intern Development assistant Development officer Dietitian Head of digital and short form Digital degree apprentice Digital engagement apprentice Digital content producer Digital marketing apprentice Digital marketing exec Digital transformation lead (project manager) Director in fashion wholesale Director in photography Director for sports TV Director at a music publisher Director at a gaming company Studio director Ambulance dispatcher Emergency medical dispatcher: call taker DJ and presenter DJ producer Accident and emergency doctor Air ambulance doctor Drama facilitator Festival PR director Festival programme director Drone operator Drummer for Kylie Civil engineering apprentice Civil engineering technician Digital engagement apprentice Ecologist Editor Content editor Educational support officer Educational wellbeing specialist Electrician Emergency medical dispatcher: call taker Emergency medical technician Engagement manager Acoustic engineer Aerospace engineer Aircraft engineer Audio engineer and musician Electrical design engineer Junior simulation engineer Sound engineer Tendering engineer Construction site engineer Electrical engineer Engineering apprentice Engineering technician Electrical engineer apprentice Apprentice engineer Formula 1 Engineer Senior system engineer Structural engineer Entrepreneur: clothing manufacturer Ergonomist Estate agent Events assistant Coding events manager Events curator Executive assistant Senior content executive Farmer Farming union policy advisor Farrier Fashion designer Festival PR director Festival programme director Field technician Film director Freelance filmmaker Filmmaker, sports Filmmaker and vlogger Financial advisor Financial service administrator Firefighter apprentice Firefighter in London Firefighter in Nottingham Firefighter in Wales Florist Foley artist Chef and food vlogger Food and drink project planner Football coach – Bryan Football coach – Renee Front of house usher Fundraising development officer Games designer Gaming company director Garden designer Glass-maker Globemaker Graphic designer Graphic designer on Harry Potter Vlogger: graphic design Groundstaff Tour (tourist) guide Newborn hearing screener Art historian Horse riding instructor Hospital receptionist Humanitarian worker Hairdresser: for people with additional needs Hairdresser apprentice Public health officer Healthcare assistant: Illustrator Vlogger: illustrator Innovation manager Ski instructor Intern working on a medical app Intern working in business development Interpretation officer (zookeeper) IT support analyst Jewellery maker Apprentice joiner Apprentice journalist Journalist: Correspondent Journalist: Associate editor Journalist: online news Journalist: online sports Journalist: science Karate instructor trainee Kitchen assistant Back of house (Kitchen) assistant Kitchenware maker Knitwear designer Landscape assistant Speech and language therapist Climate change lawyer Digital transformation lead (project manager) Studio operations lead Lifeguard Lighting director Lighting technician Locations manager Machine operator Make up artist and businesswoman Makeup business owner Make up lead: TV Festival build manager Coding events manager Management accountant Engagement manager Operations manager Lewis Capaldi's artist manager Process optimisation manager Production manager: Assistant restaurant manager Sales performance manager Social brand manager Stage manager for BBC Introducing Stage Stage manager at festivals Streaming manager Managing director of a start-up company Maritime operations officer for Her Majesty's Coastguard Marketing manager Digital marketing apprentice Digital marketing assistant: Jack's story Digital marketing assistant: Vanessa's story Digital marketing specialist Digital marketing entrepreneur Digital marketing exec Marketing intern Marketing and communications intern Marketing executive Marketing manager Apprentice mechanic Motorbike mechanic Mechanical engineer Media assistant Assistant media scheduler Medical student: Medicine management technician Emergency medical technician Member of Youth Parliament Membership coordinator in a museum Community midwife Mineral technology apprentice Model and mental health advocate Model and business owner Model shop apprentice Music business owner and DJ Music curator Music director Music editor Music festival volunteer Music manager Music news reporter Music playlist editor Music photographer Music PR manager Music promoter Music supervisor Musician Nanny Naval architect News editor: online sports News reporter Nurse Nursery worker Occupational therapy assistant Occupational therapy technical instructor Apprentice countryside officer Assistant learning officer Online entrepreneur in beauty retail Studio operations lead Operations manager Process optimisation manager Ornithologist Orthotist Outreach officer at a youth club Outreach officer in the fire service Outreach pastor Festival PR director Festival programme director Paper maker Paralegal apprentice Paramedic Party planner Patient support and engagement team administrator PPC (Pay Per Click) trainer Writer, performer and translator Personal trainer Pet food business owner Pharmacist Pharmacologist Photographer Physicist Physiotherapist Director in photography Pilot: air ambulance Plumber Podiatry assistant Poet and writer Police officer Police sergeant Politician Production management assistant Portuguese and Spanish translator Post-production: CGI Production manager Presenter Press office assistant Press officer for the North West Ambulance Service Press officer Primary teacher: Toby's story Primary teacher: Hollie's story Process optimisation manager Producer Production accountant Production assistant Product designer Professional gamer Trainee prop hand Prop maker Prosthetic makeup artist Prosthetist Public health officer Public relations account assistant Pundit Apprentice quantity surveyor Therapeutic radiographer Radio presenter – Swarzy Radio presenter – Niall Radio presenter – Katie Radio presenter and producer Radio and podcast presenter Radio producer Radio visualisation Ramp agent: Rap workshop teacher and youth ambassador Receptionist Hospital receptionist Recruitment consultant: Recruitment apprentice Public relations officer Remote vehicle operator: nuclear site Cyber security reporter Music news reporter Jobs in research Research scientist and PhD student Media researcher Media researcher Media researcher: TV Senior researcher Science student and researcher Senior research manager Restaurant assistant manager Restaurant owner Rugby coach apprentice Science apprentice Laboratory scientist apprentice Science journalist Science officer Science researcher Research scientist and PhD student Sludge scientist Newborn hearing screener Screenwriter Script editor Secretary SEO assistant Zero waste shopkeeper Shop shift leader Silversmith Singer-songwriter Jade Bird Lewis Capaldi singer-songwriter Ski instructor Ski racer Social brand manager Social media chef Songwriter for Kylie Software developer Software engineer Software engineer apprentice Solar farm manager Soldier Junior soldier Solicitor (apprentice) Solicitor (civil law) Sonographer Sound engineer: Portuguese and Spanish translator Speech and language therapist Sport psychologist Stage manager for the BBC Introducing Stage Strategist Stage manager at festivals Steel fabricator Story editor Structural engineer Studio director Studio operations lead Stunt performer Supervisor Support worker Talent acquisition manager Teacher Tech entrepreneur Technical theatre apprentice Lighting technician Emergency medical technician Medicine management technician Creative technologist Minerals technology apprentice Tennis player Therapeutic radiographer Speech and language therapist Tour (tourist) guide Tour manager PPC (Pay Per Click) trainer Digital transformation lead (project manager) Writer, performer and Cornish translator Portuguese and Spanish translator Travel consultant Tree surgeon TV presenter TV presenter Twitter curator User experience designer Urgent care desk paramedic Front of house usher Vet Veterinary nurse Veterinary surgeon Trainee vision supervisor Visual effects artist Vlogger and illustrator Volcano vlogger Chef and food vlogger Wardrobe assistant Waste warrior Web developer Wedding dress designer Welder Craft woodworker Woodworker Apprentice wing designer Writer YouTuber: gardening YouTuber and presenter Zookeeper: apprentice Zookeeper: interpretation officer Zoologist: graduate ecologist What is your trading name? What is your trade / occupation? Advertising Contractor -Ex Board Erection Advertising Contractor -Ex Board Erection Air Conditioning- Domestic Air Conditioning- Domestic and Light Commercial Air Conditioning – Industrial Alarm Installation and Maintenance-Domestic and Light Commercial Artexing/Artexers -Internal Awning Erectors Bathroom/Kitchen Design & Installation Blind Installers Boiler Servicing-Domestic Boiler Servicing-Domestic and Light Commercial Bricklayer(s) Building Contractor -PDH/Shops/Offices Building Contractors – PDH/Shops/Offices/Commercial Cable TV Installer (ex groundwork) Car Valeting Car Window Etching Carpenter and Joiner -Internal Carpet Fitting Carpet/Upholstery/Curtain Cleaning Carport Erectors Cavity Wall Installers CCTV/Closed Circuit TV Installation Ceiling & Partitioning Contractors Central Heating Installers -Domestic Central Heating Installers -Domestic and Light Commercial Chair/Stair Lift Installation Chimney Sweep Cleaning Contractors -Internal and Ex Industrial Conservatory Installation / Conservatory Installers Curtain & Blind Fitters/Installers Damp Proofing & Dry Rot Control Decorators -Domestic and Light Commercial Domestic Appliance Repairers/Maintainers Double Glazing Installers Drain Cleaners Drain Repairers Draught Proofing Drive Laying Dry Lining Dry Stone Walling – Construction and Maintenance Ductwork Installers/Installation -Commercial Electrical Contractors -Domestic Electrical Contractors -Domestic and Light Commercial Electrical Contractors -Industrial Exhibition Stand Erector / Erection – Excluding Spectator Stands Fencing Contractor(s) Fireplace Installation Fitted Furniture Installers Fitted Kitchen Installer(s) Floor Cleaning Services Flooring Contractors French Polisher Garage Door & Gate Fitters Garage Shed & Carport Erectors Garden Machinery Repair & Maintenance Gardening/Landscaping Services -Ex Tree Felling Gas Fitters -Domestic Gas Fitters -Domestic and Light Commercial Glaziers -Domestic and Commercial Gravedigging Gutter Cleaners Guttering & Fascia Board Installation Gym Equipment Fitters Handyman (Property Maintenance only) Heating/Ventilation/Air Con Contractors -Domestic Heating/Ventilation/Air Con Contractors -Domestic and Light Commecrcial Heating/Ventilation/Air Con Contractors -Industrial Hod Carriers Insulation Contractor -Internal Joiners and Carpenters Internal Landscape Gardeners/Gardening (Ex Tree Felling) Lighting Engineer – Domestic Lighting Engineer – Domestic and Light Commercial Lighting Engineer -Industrial Locksmith Loft Conversion Loft Insulation Marquee Hirer Mastic Sealant Contractor -Internal Office Equipment Installers & Repairers Office Fitters Painters & Decorators -Domestic Painters & Decorators -Domestic and Light Commercial Partition Contractor Path Laying Patio Laying Pebble Dashers Pest and Vermin Control Plasterers -Internal Plumbing & Heating Engineers -Domestic Plumbing & Heating Engineers -Domestic and Commercial Property Maintenance -PDH/Shop/Offices Refigeration Engineer Roller Shutter Door Installation Safe Installation & Removal Shop Fitters Sign Erectors Signwriting Solar Panel Installers- Domestic and Commercial Soundproofers Stone Masonry Construction and Repair -Domestic and Commercial Swimming Pool Construction -Domestic Telecommunication Installation / Maintenance Internal Thermal Insulation Installers Tilers Timber Decking Contractors Upholsterers Upholstery & Furniture Repair Wheelie Bin Cleaners/Cleaning Window Cleaners/Cleaning -Domestic and Commercial Other What type of cover would you like? * Who will be driving the vehicles? * Insured Only Insured Only Insured and Named Driver Employees Any Driver What type of licence do you hold? * How many years has it been you had this license? Do you have any DVLA-reportable medical conditions or disabilities? * Select any DVLA-reportable medical conditions or disabilities: DVLA aware - No Restrictions DVLA aware - No Restrictions DVLA aware - 1Yr restricted license DVLA aware - 2Yr restricted license DVLA aware - 3Yr restricted license DVLA unaware Do you have a valid Institute of Advanced Motorists (IAM) certificate? * Claims and convictions In the last five years, have you had or caused any accidents, claims or damage involving any motor vehicle (including cars, motorbikes and/or vans), even if no claim was made and regardless of blame? * Please enter details of any accidents, claims or damages
Include dates of events, Values of claims and outcomes.
In the last five years have you received any motoring convictions, driving licence endorsements or fixed penalties, and/or have you been disqualified from driving (including any pending prosecutions)? * Please enter details of convictions
Enter dates of convictions, full details of convictions and outcomes.
Do you have any unspent non-motoring criminal convictions? * Please enter details of non motoring unspent criminal convictions
Include as much detail as possible, dates of convictions, outcomes etc.