Kit car insurance Quotation Form

component cars, specialist car insurance, advice claims

Kit Car Insurance

Specialist Car Quotation Form

Additional discounts may be awarded
Please tell us if you have - a second car, a no claims bonus, any recent claims or convictions -
the more we know the more competitice the premium

Details about yourself:

Title	Post Code
First Name	Date of Birth
Surname	Are you Married	Yes No
House Name / Number	Occupation
Street	Daytime Tel
Town	Email
Period of UK driving licence held	Re-type Email for confirmation

Details about your car:

Make and Model		Where is it stored/kept
Engine Size		If other please specify
Est Value		Year of Registration
How long have owned the vehicle		Current mileage

Details of discounts: Select Scheme Required:

Mileage restriction		A Combined Policy	Standard
Number of years no claims bonus		Club Members
Did you build the vehicle yourself?	Yes No

Age of your Property
No. of Bedrooms

Club Name
Membership Number

What no claims (NCB) do you have on your other / company vehicle?

What type of vehicles have you driven in the past?

Have you had any accidents or losses in the past three years?	Yes No
If yes please give details

Have you have any convictions in the past 5 years?	Yes No
If yes please give details

+44 (0)20 8388 6000

+44 (0)20 8388 6055

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