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Kit Car Insurance
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  Specialist Car Quotation Form 

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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

Some questions are mandatory and are marked with *

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 *
Insurance Renewal Date Current Insurer

Details of discounts:                                                                 Select Scheme Required:

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

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

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+44 (0)20 8388 6000
+44 (0)20 8388 6000
+44 (0)20 8388 6055
+44 (0)20 8388 6055

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