Motor and/or Property

Important notice: Please complete all sections to enable us to select which of our policies best suit you. Our team will then contact you with full details of covers and an indication of premium. Do not worry if there is not enough space, complete what you can and in the comments box at the bottom just asking us to call for more detail. If you wish to phone for a quote you can do so on 0845 450 0648.

*entry required

 
About You

 

Title:

Other (please specify):

*Your Name (first and surname):

Trading Name:

*Correspondence Full Address:

Correspondence Post Code:

Risk Address (if different):

Risk Post Code (if different):

*Date of Birth:

*Telephone (Daytime):

Telephone (Evenings):

Mobile:

Fax:

Email Address:

List of Funeral Services Provided:

Detail of any Society Membership i.e. NAFD/SAIF:

 
Buildings

 

Complete Buildings detail even if you only want Contents Cover, just leave Require Cover as "NO".

Do you require Buildings Cover:

Renewal Date:

Buildings (brief description i.e. brick and tile):

Select Property Type:

Claims in the last 3 years:

Claims Value:

Sum to Insure (rebuild value):

Year Built:

Current Insurer (company not broker):

 

Contents and Business Package

 

Annual Turnover:

Stock in Trade:

General Contents Value (plant ect):

Wages for Clerical Staff:

Wages to Woodworking Staff:

Claims in the last 3 years:

Current Insurer (company not broker):

Renewal Date:

Fixtures and Fittings:

Shop Front Value:

Wages for Non Clerical Staff:

Total Company Wages:

Claims Value:

 
Motor (being all your Private Hire Vehicles)

 

Do you require Motor Cover?

Renewal Date:

 

 

1) Vehicle - make and model:
  
 
CC:
  
 
Year:
  
 
Value:
  
 
Cover Type:
 
NCB Years:
 
Vehicle Type:
 
Garage:

 

 

2) Vehicle - make and model:
  
 
CC:
  
 
Year:
  
 
Value:
  
 
Cover Type:
 
NCB Years:
 
Vehicle Type:
 
Garage:

 

 

3) Vehicle - make and model:
  
 
CC:
  
 
Year:
  
 
Value:
  
 
Cover Type:
 
NCB Years:
 
Vehicle Type:
 
Garage:

 

 

4) Vehicle - make and model:
  
 
CC:
  
 
Year:
  
 
Value:
  
 
Cover Type:
 
NCB Years:
 
Vehicle Type:
 
Garage:

 

 

5) Vehicle - make and model:
  
 
CC:
  
 
Year:
  
 
Value:
  
 
Cover Type:
 
NCB Years:
 
Vehicle Type:
 
Garage:

 

 

6) Vehicle - make and model:
  
 
CC:
  
 
Year:
  
 
Value:
  
 
Cover Type:
 
NCB Years:
 
Vehicle Type:
 
Garage:

 

 

Any drivers under 21 years:

Claims in the last 3 years:

Claims Value:

Current Insurer (company not broker):

If you have more than 1 property or more than 6 vehicles please call the number on the main page.

 
 

 

Where did you hear about us:

COMMENTS BOX
please enter any other information you wish relating to your requirements.

Data Protection. We may share the information given with the SEIB Group of companies and or other associated companies who can help us enhance our products and services to you. If you do not wish to receive or have your information shared then please change the box to read "NO".