Car Insurance Quote

Please complete all required * fields to obtain a quotation. Your quotation is based on the accuracy of the information provided. If for any reason your information is inaccurate, then this quote is invalid.

Cover Details

Cover required from date*

Cover date must be within the next 30 days.

Please note immediate cover is not available and can require up to 24 hours before cover is confirmed.

Personal Details

Title*

-- Please select -- Miss Mrs Ms Mr Br Dr Fr Prof Rev Sr

First Name*

Surname*

Post Code*

Valid formats are: "bt6 2ab" and "bt652ab".

Click to verify

Confirm postal address

We need to match your postal address to the official Post Office listing. Please fill in your address and click on the Confirm postal address button.

Please confirm your exact address

-- Please select --

(This should be the address where your car is kept over night.) Edit your address

Other Details

Home telephone

Mobile number*

Email address*

Date of Birth*

/ /

Gender*

Male Female

We require this information for actuarial purposes and do not use it for rating purposes.

Employment Status*

-- Please select -- Employee Housewife/Husband Part-time Employee Retired Self Employed Unemployed

Current Occupation*

-- Please select -- Account Executive Accountant Accountant - Turf Accounts Manager Accounts Staff Actor / Actress Actuary Administration Staff Administrator Advertising Agent Advertising Manager Advertising Staff Aerobic/Keep Fit Instruc Agricultural Engineer Agricultural Worker Air Force - NCO/CO Air Force - Other Ranks Air Traffic Controller Aircraft - Cabin Crew Airline Check-in Staff Airline Emp - Non Airport Airline Emp. - Airport Ambulance Crew Ambulance Driver Animal Trainer Apprentice Archaelogist Architect Architect's Technician Army - NCO/CO Army - Other Ranks Artist Assembly Worker Assessor Assistant Manager Au Pair Auctioneer Auditor Baker Bank Manager Bank Staff Bar Manager Bar Staff Barber Barrister Beautician Biologist Bricklayer Broadcaster - Radio / TV Builder Builders Labourer Builders Merchant Building Contractor Building Foreman Bus Company Employee Bus Driver Business Consultant Butcher Buyer Cabinet Maker Cafe Owner Cafe Staff Call Centre Staff Car Salesman Care Assistant Caretaker Carpenter Cashier Caterer Catering Staff Chef Chemist Child Minder Chiropodist Civil Servant Cleric Clerk Collector - Door to door Community Worker Company Director Company Secretary Computing Construction Worker Consultant - Medical Contractor - Haulage Cook Counsellor Courier Craftsman Crane Operator Credit Controller Customs and Excise Officer Delivery Roundsman Dental Nurse Dentist Designer Dietician Disc Jockey Doctor - Medical Domestic Help Draughtsman Dressmaker Driver - Fork Lift Driver - HGV Driver - Hire Car Driver - Hot Food Delivery Driver - Plant Driver - PSV Driver - Taxi Driver - Train Driver - Van Driving Instructor Economist Editor Electrician Embassy Staff - Foreign Engineer Engineer - Chemical Engineer - Civil Engineer - Electrical Engineer - Electronic Engineer - Marine Engineer - Mechanical Entertainer Estate Agent Fabricator Factory Worker Farm Worker Farmer Financial Advisor Financial Analyst Financier Firefighter Fisherman Fitness Instructor Fitter Fitter - Tyre / Exhaust Florist Forestor Furniture Restorer Gardener General Manager General Worker Geologist Glass Worker Glazier Green Keeper Groundsman Guest House Proprietor Hairdresser Health and Safety Officer Health Service Employee Home Help Homeopath Horticulturalist Hospital Technician Hotelier House Parent Househusband Housekeeper Housewife Insurance Broker Insurance Staff Interior Decorator Jeweller Journalist Kitchen Worker Laboratory Technician Labourer Landlord Landscape Gardener Lecturer Legal Executive Librarian Licensing Consultant Life Assurance Salesman Machinist Maintenance Staff Manager - Administration Manager - Retail Shop Managing Director Manufacturing Agent Market Researcher Market Trader Marketing Mature Student Mechanic Metal Worker Microbiologist Milkman Motor Trader Navy - NCO/Com. Officer Navy - Other Ranks Nurse Occupational Therapist Optician Painter Painter and Decorator Panel Beater Personnel Manager Pharmacist Photographer Physiologist Physiotherapist Pilot Plant Manager Plasterer Plumber Police Personnel Porter Post Office Staff Postman/Postwomen Printer Prison Officer Producer - Film/Radio/TV Production Engineer Production Manager Professional Sportsperson Project Manager Property Developer Psychologist Public Relations Publican Publisher Quality Controller Quantity Surveyor Radiographer Railway Staff Receptionist Researcher Restaurant Manager Restauranteur Retired Roofer Sales - Travelling Sales Assistant Sales -Non Travelling Scientist Seaman Secretary Security Service Engineer Sheet Metal Worker Shop Proprietor Shop Proprietor - Mobile Site Engineer Social Worker Solicitor Speech Therapist Steel Worker Stock Controller Stonemason Storeman / Woman Student Student Teacher Supervisor Surveyor Teacher Teacher - Principal/Vice-Princ Teachers Assistant Tech - Electronic Tech - Food Tech - Telecom Technical Author Telephone Engineer Telephonist Telesales Person Therapist Tiler Tool Maker Town Planner Traffic Warden Trainer Training Manager Translator Travel Consultant Unemployed Upholsterer Veterinary Surgeon Waiter / Waitress Warehouse Manager Warehouseman/Woman Welder Welfare Officer Window Cleaner Wood Worker Writer Zoologist

If you are currently unemployed or retired please select your previous occupation. If you can't find your occupation, please contact us on 028 90 828 828. Click the dropdown list and type the first letter of your occupation.

How many miles do you travel to work in your car*

-- Please select -- 0 Miles 1 Mile 2 Miles 3 Miles 4 Miles 5 Miles 6 Miles 7 Miles 8 Miles 9 Miles 10 Miles 11 Miles 12 Miles 13 Miles 14 Miles 15 Miles 16 Miles 17 Miles 18 Miles 19 Miles 20 Miles 21 Miles 22 Miles 23 Miles 24 Miles 25 Miles 26 Miles 27 Miles 28 Miles 29 Miles 30 Miles 31 Miles 32 Miles 33 Miles 34 Miles 35 Miles 36 Miles 37 Miles 38 Miles 39 Miles 40 Miles 41 Miles 42 Miles 43 Miles 44 Miles 45 Miles 46 Miles 47 Miles 48 Miles 49 Miles 50 Miles 51 Miles 52 Miles 53 Miles 54 Miles 55 Miles 56 Miles 57 Miles 58 Miles 59 Miles 60 Miles 61 Miles 62 Miles 63 Miles 64 Miles 65 Miles 66 Miles 67 Miles 68 Miles 69 Miles 70 Miles 71 Miles 72 Miles 73 Miles 74 Miles 75 Miles 76 Miles 77 Miles 78 Miles 79 Miles 80 Miles 81 Miles 82 Miles 83 Miles 84 Miles 85 Miles 86 Miles 87 Miles 88 Miles 89 Miles 90 Miles 91 Miles 92 Miles 93 Miles 94 Miles 95 Miles 96 Miles 97 Miles 98 Miles 99 Miles 100 Miles

If you drive to work in your car, please select the number of miles from your home to your place of employment (one-way journey only).If you do not use your car to commute to work, are working in the home, retired or unemployed, please select '0' miles.

Licence Type*

-- Please select -- Full UK Provisional UK Full Irish Irish Learner Permit Full European Other

If you do not have current valid UK or EU Licence please call us on 028 90 828 828.

Date first licenced if provisional/ Date test passed if full*

/ / This date is printed on your driving license.

Driver Number

 

If your driver number is longer than 10 characters please call us for a quote on 028 90 828 828. On Irish Licences, your driver number is a 9 digit number that appears in field 5 of your paper licence and in field 4d of the new plastic card licence or permit e.g. 100143471. If you do not have your licence at present please leave blank. Note you will not be able to buy this policy without entering your driver number. The Date of Birth that you provided does not match the Date of Birth associated with this Driver Number.

Would you like cover for your partner, if applicable?*

Yes No

To add an additional driver other than your partner, please call us on 028 90 828 828.

Your Partner Details

Title*

-- Please select -- Miss Mrs Ms Mr Br Dr Fr Prof Rev Sr

First Name*

Surname*

Date of Birth*

/ /

Gender*

Male Female

Employment Status*

-- Please select -- Employee Housewife/Husband Part-time Employee Retired Self Employed Unemployed

Current Occupation*

-- Please select -- Account Executive Accountant Accountant - Turf Accounts Manager Accounts Staff Actor / Actress Actuary Administration Staff Administrator Advertising Agent Advertising Manager Advertising Staff Aerobic/Keep Fit Instruc Agricultural Engineer Agricultural Worker Air Force - NCO/CO Air Force - Other Ranks Air Traffic Controller Aircraft - Cabin Crew Airline Check-in Staff Airline Emp - Non Airport Airline Emp. - Airport Ambulance Crew Ambulance Driver Animal Trainer Apprentice Archaelogist Architect Architect's Technician Army - NCO/CO Army - Other Ranks Artist Assembly Worker Assessor Assistant Manager Au Pair Auctioneer Auditor Baker Bank Manager Bank Staff Bar Manager Bar Staff Barber Barrister Beautician Biologist Bricklayer Broadcaster - Radio / TV Builder Builders Labourer Builders Merchant Building Contractor Building Foreman Bus Company Employee Bus Driver Business Consultant Butcher Buyer Cabinet Maker Cafe Owner Cafe Staff Call Centre Staff Car Salesman Care Assistant Caretaker Carpenter Cashier Caterer Catering Staff Chef Chemist Child Minder Chiropodist Civil Servant Cleric Clerk Collector - Door to door Community Worker Company Director Company Secretary Computing Construction Worker Consultant - Medical Contractor - Haulage Cook Counsellor Courier Craftsman Crane Operator Credit Controller Customs and Excise Officer Delivery Roundsman Dental Nurse Dentist Designer Dietician Disc Jockey Doctor - Medical Domestic Help Draughtsman Dressmaker Driver - Fork Lift Driver - HGV Driver - Hire Car Driver - Hot Food Delivery Driver - Plant Driver - PSV Driver - Taxi Driver - Train Driver - Van Driving Instructor Economist Editor Electrician Embassy Staff - Foreign Engineer Engineer - Chemical Engineer - Civil Engineer - Electrical Engineer - Electronic Engineer - Marine Engineer - Mechanical Entertainer Estate Agent Fabricator Factory Worker Farm Worker Farmer Financial Advisor Financial Analyst Financier Firefighter Fisherman Fitness Instructor Fitter Fitter - Tyre / Exhaust Florist Forestor Furniture Restorer Gardener General Manager General Worker Geologist Glass Worker Glazier Green Keeper Groundsman Guest House Proprietor Hairdresser Health and Safety Officer Health Service Employee Home Help Homeopath Horticulturalist Hospital Technician Hotelier House Parent Househusband Housekeeper Housewife Insurance Broker Insurance Staff Interior Decorator Jeweller Journalist Kitchen Worker Laboratory Technician Labourer Landlord Landscape Gardener Lecturer Legal Executive Librarian Licensing Consultant Life Assurance Salesman Machinist Maintenance Staff Manager - Administration Manager - Retail Shop Managing Director Manufacturing Agent Market Researcher Market Trader Marketing Mature Student Mechanic Metal Worker Microbiologist Milkman Motor Trader Navy - NCO/Com. Officer Navy - Other Ranks Nurse Occupational Therapist Optician Painter Painter and Decorator Panel Beater Personnel Manager Pharmacist Photographer Physiologist Physiotherapist Pilot Plant Manager Plasterer Plumber Police Personnel Porter Post Office Staff Postman/Postwomen Printer Prison Officer Producer - Film/Radio/TV Production Engineer Production Manager Professional Sportsperson Project Manager Property Developer Psychologist Public Relations Publican Publisher Quality Controller Quantity Surveyor Radiographer Railway Staff Receptionist Researcher Restaurant Manager Restauranteur Retired Roofer Sales - Travelling Sales Assistant Sales -Non Travelling Scientist Seaman Secretary Security Service Engineer Sheet Metal Worker Shop Proprietor Shop Proprietor - Mobile Site Engineer Social Worker Solicitor Speech Therapist Steel Worker Stock Controller Stonemason Storeman / Woman Student Student Teacher Supervisor Surveyor Teacher Teacher - Principal/Vice-Princ Teachers Assistant Tech - Electronic Tech - Food Tech - Telecom Technical Author Telephone Engineer Telephonist Telesales Person Therapist Tiler Tool Maker Town Planner Traffic Warden Trainer Training Manager Translator Travel Consultant Unemployed Upholsterer Veterinary Surgeon Waiter / Waitress Warehouse Manager Warehouseman/Woman Welder Welfare Officer Window Cleaner Wood Worker Writer Zoologist

Click the dropdown list and type the first letter of your occupation.

Licence Type*

-- Please select -- Full Irish Irish Learner Permit Full UK Provisional UK Full European Other

Date first licenced if provisional/ Date test passed if full*

/ / This date is printed on your driving license.

Driver Number

 

If your driver number is longer than 10 characters please call us for a quote on 028 90 828 828. On Irish Licences, your driver number is a 9 digit number that appears in field 5 of your paper licence and in field 4d of the new plastic card licence or permit e.g. 100143471. If you do not have your licence at present please leave blank. Note you will not be able to buy this policy without entering your driver number.

Total Penalty Points*

-- Please select -- 0 1 2 3 4 5 6 7 8 9 10 11 12

Issue Allianz Data Privacy Statement Via*

Email SMS Unknown

In order to comply with our obligations under the General Data Protection Regulation ('GDPR'), any person for whom we collect personal data must be made aware of how we process their information. Please provide the preferred method of contact for the person above to allow us to communicate this information to them.

If you are unable to provide these details to us, we will advise you by email of where to find our Data Privacy Statement.

Email address*

Mobile number*

Partner Penalty Points

Nature of Offence

No of Points

Date Points Received

-- Please select -- Aggravated vehicle taking/causing damage Aggravated vehicle taking/causing injury Attempting to drive while unfit from drink/drugs Attempting to drive with excess alcohol in blood Attempting to drive with excess alcohol in breath Attempting to drive with excess alcohol in urine Breach of traffic sign Careless Driving Carrying unauthorised passenger on motorcycle Causing an accident with defective braking system Causing an accident with defective steering Causing an accident with no driving licence Causing death by inconsiderate driving when unfit Causing death by inconsiderate driving with excess alcohol Child under 12/135cm no restraints Child under 14 no seat belt Dangerous driving Death by careless driving providing no specimen Death by careless driving providing no specimen Death by careless driving when unfit Death by dangerous driving Death by inconsiderate driving no specimen Death by reckless driving Defective steering Defective tyre Defective tyres Driving a car with an unrestrained child under 12 Driving a vehicle and failing to notify disability Driving classified vehicle on sp road Driving not in control of vehicle Driving on a buslane on motorway Driving on hard shoulder motorway Driving under age Driving while disqualified Driving while disqualified until tested Driving while unfit drink/drugs Driving with excess alcohol in blood Driving with excess alcohol in urine Driving with no control of vehicle Driving with no view of road/traffic Driving without consideration for others Driving without due care/attention Exceed 45 MPH displaying R plates Exceed 45 MPH with L plates Exceed height of semi-trailer Exceed special speed limit Exceed temporary speed limit Excess alcohol Excess alcohol in breath Excess speed Excess speed drawing trailer Excess speed vehicle classification Failing to give correct name/address Failing to give driver information Failing to give info about owner Failing to give particulars-damage Failing to give passenger name/address Failing to obey signal by constable Failing to particulars injury only Failing to precedence zebra crossing Failing to precedence zebra crossing Failing to provide blood/urine sample Failing to provide preliminary breath test Failing to provide specimen breath analysis Failing to provide specimen excess alcohol Failing to remain at scene-damage Failing to remain at scene-injury Failing to report damage only accident Failing to report injury only accident Failing to set handbrake Failing to stop at pelican crossing Failing to stop for school crossing patrol Failing to stop-injury accident Failing to stop-injury accident Failing to wear seat belt-driver Furious driving GBH by dangerous driving GBI by driving car while seriously unfit GBI by inconsiderate driving when unfit GBI by inconsiderate driving with excess alcohol GBI careless driving/no specimen GBI driving car with excess alcohol GBI inconsiderate driving/no specimen Hold mobile phone while driving In charge of vehicle with excess alcohol in blood In charge of vehicle with excess alcohol in breath In charge of vehicle with excess alcohol in urine L driver carrying passenger on motorcycle L driver on motocycle over 250cc L driver on motocycle over 250cc Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No specimen/ attempting to drive with excess alcohol No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/in charge of a vehicle whilst unfit On hard shoulder longer than necessary On hard shoulder longer than necessary Overtaking moving vehicle at zebra crossing Overtaking stationary vehicle at zebra crossing Parked on clearway - AM Parked on clearway - AM Parked on clearway - PM Parked on footway adjacent to clearway Parked on hard shoulder motorway Parked within limits of pelican crossing Parked within limits of zebra crossing Parking in dangerous position Parking within 15M of junction Parking within 15M of junction Parking within 15M of junction Refusing eyesight test Refusing eyesight test Reversing from minor road to main road Reversing from minor road to main road Stop on approach to pelican crossing Stop within limit of zebra area Stop within limit of zebra area Typres insufficient for axle wght Typres insufficient for axle wght Unaccompanied HGV L driver(GCV/PCV) Unaccompanied L driver Unaccompanied L driver (GCV/PCV) Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Using goods vehicle in dangerous cont Using mobile phone while driving Using passenger vehicle in dangerous cont Using passenger vehicle in dangerous cont Using veh with defect brakes Using vehicle in dangerous condition Using vehicle not insured for TP Using vehicle without cert of roadworthy

-- Please select -- 1 2 3 4 5 6 7 8 9 10 11 12

/ /

-- Not selected -- Aggravated vehicle taking/causing damage Aggravated vehicle taking/causing injury Attempting to drive while unfit from drink/drugs Attempting to drive with excess alcohol in blood Attempting to drive with excess alcohol in breath Attempting to drive with excess alcohol in urine Breach of traffic sign Careless Driving Carrying unauthorised passenger on motorcycle Causing an accident with defective braking system Causing an accident with defective steering Causing an accident with no driving licence Causing death by inconsiderate driving when unfit Causing death by inconsiderate driving with excess alcohol Child under 12/135cm no restraints Child under 14 no seat belt Dangerous driving Death by careless driving providing no specimen Death by careless driving providing no specimen Death by careless driving when unfit Death by dangerous driving Death by inconsiderate driving no specimen Death by reckless driving Defective steering Defective tyre Defective tyres Driving a car with an unrestrained child under 12 Driving a vehicle and failing to notify disability Driving classified vehicle on sp road Driving not in control of vehicle Driving on a buslane on motorway Driving on hard shoulder motorway Driving under age Driving while disqualified Driving while disqualified until tested Driving while unfit drink/drugs Driving with excess alcohol in blood Driving with excess alcohol in urine Driving with no control of vehicle Driving with no view of road/traffic Driving without consideration for others Driving without due care/attention Exceed 45 MPH displaying R plates Exceed 45 MPH with L plates Exceed height of semi-trailer Exceed special speed limit Exceed temporary speed limit Excess alcohol Excess alcohol in breath Excess speed Excess speed drawing trailer Excess speed vehicle classification Failing to give correct name/address Failing to give driver information Failing to give info about owner Failing to give particulars-damage Failing to give passenger name/address Failing to obey signal by constable Failing to particulars injury only Failing to precedence zebra crossing Failing to precedence zebra crossing Failing to provide blood/urine sample Failing to provide preliminary breath test Failing to provide specimen breath analysis Failing to provide specimen excess alcohol Failing to remain at scene-damage Failing to remain at scene-injury Failing to report damage only accident Failing to report injury only accident Failing to set handbrake Failing to stop at pelican crossing Failing to stop for school crossing patrol Failing to stop-injury accident Failing to stop-injury accident Failing to wear seat belt-driver Furious driving GBH by dangerous driving GBI by driving car while seriously unfit GBI by inconsiderate driving when unfit GBI by inconsiderate driving with excess alcohol GBI careless driving/no specimen GBI driving car with excess alcohol GBI inconsiderate driving/no specimen Hold mobile phone while driving In charge of vehicle with excess alcohol in blood In charge of vehicle with excess alcohol in breath In charge of vehicle with excess alcohol in urine L driver carrying passenger on motorcycle L driver on motocycle over 250cc L driver on motocycle over 250cc Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No specimen/ attempting to drive with excess alcohol No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/in charge of a vehicle whilst unfit On hard shoulder longer than necessary On hard shoulder longer than necessary Overtaking moving vehicle at zebra crossing Overtaking stationary vehicle at zebra crossing Parked on clearway - AM Parked on clearway - AM Parked on clearway - PM Parked on footway adjacent to clearway Parked on hard shoulder motorway Parked within limits of pelican crossing Parked within limits of zebra crossing Parking in dangerous position Parking within 15M of junction Parking within 15M of junction Parking within 15M of junction Refusing eyesight test Refusing eyesight test Reversing from minor road to main road Reversing from minor road to main road Stop on approach to pelican crossing Stop within limit of zebra area Stop within limit of zebra area Typres insufficient for axle wght Typres insufficient for axle wght Unaccompanied HGV L driver(GCV/PCV) Unaccompanied L driver Unaccompanied L driver (GCV/PCV) Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Using goods vehicle in dangerous cont Using mobile phone while driving Using passenger vehicle in dangerous cont Using passenger vehicle in dangerous cont Using veh with defect brakes Using vehicle in dangerous condition Using vehicle not insured for TP Using vehicle without cert of roadworthy

-- Not selected -- 1 2 3 4 5 6 7 8 9 10 11 12

/ /

-- Not selected -- Aggravated vehicle taking/causing damage Aggravated vehicle taking/causing injury Attempting to drive while unfit from drink/drugs Attempting to drive with excess alcohol in blood Attempting to drive with excess alcohol in breath Attempting to drive with excess alcohol in urine Breach of traffic sign Careless Driving Carrying unauthorised passenger on motorcycle Causing an accident with defective braking system Causing an accident with defective steering Causing an accident with no driving licence Causing death by inconsiderate driving when unfit Causing death by inconsiderate driving with excess alcohol Child under 12/135cm no restraints Child under 14 no seat belt Dangerous driving Death by careless driving providing no specimen Death by careless driving providing no specimen Death by careless driving when unfit Death by dangerous driving Death by inconsiderate driving no specimen Death by reckless driving Defective steering Defective tyre Defective tyres Driving a car with an unrestrained child under 12 Driving a vehicle and failing to notify disability Driving classified vehicle on sp road Driving not in control of vehicle Driving on a buslane on motorway Driving on hard shoulder motorway Driving under age Driving while disqualified Driving while disqualified until tested Driving while unfit drink/drugs Driving with excess alcohol in blood Driving with excess alcohol in urine Driving with no control of vehicle Driving with no view of road/traffic Driving without consideration for others Driving without due care/attention Exceed 45 MPH displaying R plates Exceed 45 MPH with L plates Exceed height of semi-trailer Exceed special speed limit Exceed temporary speed limit Excess alcohol Excess alcohol in breath Excess speed Excess speed drawing trailer Excess speed vehicle classification Failing to give correct name/address Failing to give driver information Failing to give info about owner Failing to give particulars-damage Failing to give passenger name/address Failing to obey signal by constable Failing to particulars injury only Failing to precedence zebra crossing Failing to precedence zebra crossing Failing to provide blood/urine sample Failing to provide preliminary breath test Failing to provide specimen breath analysis Failing to provide specimen excess alcohol Failing to remain at scene-damage Failing to remain at scene-injury Failing to report damage only accident Failing to report injury only accident Failing to set handbrake Failing to stop at pelican crossing Failing to stop for school crossing patrol Failing to stop-injury accident Failing to stop-injury accident Failing to wear seat belt-driver Furious driving GBH by dangerous driving GBI by driving car while seriously unfit GBI by inconsiderate driving when unfit GBI by inconsiderate driving with excess alcohol GBI careless driving/no specimen GBI driving car with excess alcohol GBI inconsiderate driving/no specimen Hold mobile phone while driving In charge of vehicle with excess alcohol in blood In charge of vehicle with excess alcohol in breath In charge of vehicle with excess alcohol in urine L driver carrying passenger on motorcycle L driver on motocycle over 250cc L driver on motocycle over 250cc Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No specimen/ attempting to drive with excess alcohol No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/in charge of a vehicle whilst unfit On hard shoulder longer than necessary On hard shoulder longer than necessary Overtaking moving vehicle at zebra crossing Overtaking stationary vehicle at zebra crossing Parked on clearway - AM Parked on clearway - AM Parked on clearway - PM Parked on footway adjacent to clearway Parked on hard shoulder motorway Parked within limits of pelican crossing Parked within limits of zebra crossing Parking in dangerous position Parking within 15M of junction Parking within 15M of junction Parking within 15M of junction Refusing eyesight test Refusing eyesight test Reversing from minor road to main road Reversing from minor road to main road Stop on approach to pelican crossing Stop within limit of zebra area Stop within limit of zebra area Typres insufficient for axle wght Typres insufficient for axle wght Unaccompanied HGV L driver(GCV/PCV) Unaccompanied L driver Unaccompanied L driver (GCV/PCV) Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Using goods vehicle in dangerous cont Using mobile phone while driving Using passenger vehicle in dangerous cont Using passenger vehicle in dangerous cont Using veh with defect brakes Using vehicle in dangerous condition Using vehicle not insured for TP Using vehicle without cert of roadworthy

-- Not selected -- 1 2 3 4 5 6 7 8 9 10 11 12

/ /

-- Not selected -- Aggravated vehicle taking/causing damage Aggravated vehicle taking/causing injury Attempting to drive while unfit from drink/drugs Attempting to drive with excess alcohol in blood Attempting to drive with excess alcohol in breath Attempting to drive with excess alcohol in urine Breach of traffic sign Careless Driving Carrying unauthorised passenger on motorcycle Causing an accident with defective braking system Causing an accident with defective steering Causing an accident with no driving licence Causing death by inconsiderate driving when unfit Causing death by inconsiderate driving with excess alcohol Child under 12/135cm no restraints Child under 14 no seat belt Dangerous driving Death by careless driving providing no specimen Death by careless driving providing no specimen Death by careless driving when unfit Death by dangerous driving Death by inconsiderate driving no specimen Death by reckless driving Defective steering Defective tyre Defective tyres Driving a car with an unrestrained child under 12 Driving a vehicle and failing to notify disability Driving classified vehicle on sp road Driving not in control of vehicle Driving on a buslane on motorway Driving on hard shoulder motorway Driving under age Driving while disqualified Driving while disqualified until tested Driving while unfit drink/drugs Driving with excess alcohol in blood Driving with excess alcohol in urine Driving with no control of vehicle Driving with no view of road/traffic Driving without consideration for others Driving without due care/attention Exceed 45 MPH displaying R plates Exceed 45 MPH with L plates Exceed height of semi-trailer Exceed special speed limit Exceed temporary speed limit Excess alcohol Excess alcohol in breath Excess speed Excess speed drawing trailer Excess speed vehicle classification Failing to give correct name/address Failing to give driver information Failing to give info about owner Failing to give particulars-damage Failing to give passenger name/address Failing to obey signal by constable Failing to particulars injury only Failing to precedence zebra crossing Failing to precedence zebra crossing Failing to provide blood/urine sample Failing to provide preliminary breath test Failing to provide specimen breath analysis Failing to provide specimen excess alcohol Failing to remain at scene-damage Failing to remain at scene-injury Failing to report damage only accident Failing to report injury only accident Failing to set handbrake Failing to stop at pelican crossing Failing to stop for school crossing patrol Failing to stop-injury accident Failing to stop-injury accident Failing to wear seat belt-driver Furious driving GBH by dangerous driving GBI by driving car while seriously unfit GBI by inconsiderate driving when unfit GBI by inconsiderate driving with excess alcohol GBI careless driving/no specimen GBI driving car with excess alcohol GBI inconsiderate driving/no specimen Hold mobile phone while driving In charge of vehicle with excess alcohol in blood In charge of vehicle with excess alcohol in breath In charge of vehicle with excess alcohol in urine L driver carrying passenger on motorcycle L driver on motocycle over 250cc L driver on motocycle over 250cc Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No specimen/ attempting to drive with excess alcohol No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/in charge of a vehicle whilst unfit On hard shoulder longer than necessary On hard shoulder longer than necessary Overtaking moving vehicle at zebra crossing Overtaking stationary vehicle at zebra crossing Parked on clearway - AM Parked on clearway - AM Parked on clearway - PM Parked on footway adjacent to clearway Parked on hard shoulder motorway Parked within limits of pelican crossing Parked within limits of zebra crossing Parking in dangerous position Parking within 15M of junction Parking within 15M of junction Parking within 15M of junction Refusing eyesight test Refusing eyesight test Reversing from minor road to main road Reversing from minor road to main road Stop on approach to pelican crossing Stop within limit of zebra area Stop within limit of zebra area Typres insufficient for axle wght Typres insufficient for axle wght Unaccompanied HGV L driver(GCV/PCV) Unaccompanied L driver Unaccompanied L driver (GCV/PCV) Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Using goods vehicle in dangerous cont Using mobile phone while driving Using passenger vehicle in dangerous cont Using passenger vehicle in dangerous cont Using veh with defect brakes Using vehicle in dangerous condition Using vehicle not insured for TP Using vehicle without cert of roadworthy

-- Not selected -- 1 2 3 4 5 6 7 8 9 10 11 12

/ /

Please enter Date Points Received in DD/MM/YYYY format. Sum of penalty points selected must match with the total penalty points selected. Please select valid data for nature of offence and date points received (DD/MM/YYYY).

Penalty Points and Claims History

Total Penalty Points*

-- Please select -- 0 1 2 3 4 5 6 7 8 9 10 11 12

Within the past 5 years have you or other drivers had any accidents or claims (excluding windscreen) which resulted in a payment?*

Yes No

Please consider any accidents or claims on previous or existing policies where: You were driving any car; or any driver on your policy was driving your car; or any driver to be included in this quotation was driving any car; or the loss of or damage to your car resulted from fire or theft.

Within the past 5 years have there been any windscreen claims on your policy?*

Yes No

Number of claims?

-- Please select -- One Two Three or more

Your Windscreen Claims

Claim Number

Date of Claim

Value of Claim

Claim 1

/ /

Claim 2

/ /

Please enter value of claim to the nearest £

Your Penalty Points

Nature of Offence

No of Points

Date Points Received

-- Please select -- Aggravated vehicle taking/causing damage Aggravated vehicle taking/causing injury Attempting to drive while unfit from drink/drugs Attempting to drive with excess alcohol in blood Attempting to drive with excess alcohol in breath Attempting to drive with excess alcohol in urine Breach of traffic sign Careless Driving Carrying unauthorised passenger on motorcycle Causing an accident with defective braking system Causing an accident with defective steering Causing an accident with no driving licence Causing death by inconsiderate driving when unfit Causing death by inconsiderate driving with excess alcohol Child under 12/135cm no restraints Child under 14 no seat belt Dangerous driving Death by careless driving providing no specimen Death by careless driving providing no specimen Death by careless driving when unfit Death by dangerous driving Death by inconsiderate driving no specimen Death by reckless driving Defective steering Defective tyre Defective tyres Driving a car with an unrestrained child under 12 Driving a vehicle and failing to notify disability Driving classified vehicle on sp road Driving not in control of vehicle Driving on a buslane on motorway Driving on hard shoulder motorway Driving under age Driving while disqualified Driving while disqualified until tested Driving while unfit drink/drugs Driving with excess alcohol in blood Driving with excess alcohol in urine Driving with no control of vehicle Driving with no view of road/traffic Driving without consideration for others Driving without due care/attention Exceed 45 MPH displaying R plates Exceed 45 MPH with L plates Exceed height of semi-trailer Exceed special speed limit Exceed temporary speed limit Excess alcohol Excess alcohol in breath Excess speed Excess speed drawing trailer Excess speed vehicle classification Failing to give correct name/address Failing to give driver information Failing to give info about owner Failing to give particulars-damage Failing to give passenger name/address Failing to obey signal by constable Failing to particulars injury only Failing to precedence zebra crossing Failing to precedence zebra crossing Failing to provide blood/urine sample Failing to provide preliminary breath test Failing to provide specimen breath analysis Failing to provide specimen excess alcohol Failing to remain at scene-damage Failing to remain at scene-injury Failing to report damage only accident Failing to report injury only accident Failing to set handbrake Failing to stop at pelican crossing Failing to stop for school crossing patrol Failing to stop-injury accident Failing to stop-injury accident Failing to wear seat belt-driver Furious driving GBH by dangerous driving GBI by driving car while seriously unfit GBI by inconsiderate driving when unfit GBI by inconsiderate driving with excess alcohol GBI careless driving/no specimen GBI driving car with excess alcohol GBI inconsiderate driving/no specimen Hold mobile phone while driving In charge of vehicle with excess alcohol in blood In charge of vehicle with excess alcohol in breath In charge of vehicle with excess alcohol in urine L driver carrying passenger on motorcycle L driver on motocycle over 250cc L driver on motocycle over 250cc Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No specimen/ attempting to drive with excess alcohol No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/in charge of a vehicle whilst unfit On hard shoulder longer than necessary On hard shoulder longer than necessary Overtaking moving vehicle at zebra crossing Overtaking stationary vehicle at zebra crossing Parked on clearway - AM Parked on clearway - AM Parked on clearway - PM Parked on footway adjacent to clearway Parked on hard shoulder motorway Parked within limits of pelican crossing Parked within limits of zebra crossing Parking in dangerous position Parking within 15M of junction Parking within 15M of junction Parking within 15M of junction Refusing eyesight test Refusing eyesight test Reversing from minor road to main road Reversing from minor road to main road Stop on approach to pelican crossing Stop within limit of zebra area Stop within limit of zebra area Typres insufficient for axle wght Typres insufficient for axle wght Unaccompanied HGV L driver(GCV/PCV) Unaccompanied L driver Unaccompanied L driver (GCV/PCV) Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Using goods vehicle in dangerous cont Using mobile phone while driving Using passenger vehicle in dangerous cont Using passenger vehicle in dangerous cont Using veh with defect brakes Using vehicle in dangerous condition Using vehicle not insured for TP Using vehicle without cert of roadworthy

-- Please select -- 1 2 3 4 5 6 7 8 9 10 11 12

/ /

-- Not selected -- Aggravated vehicle taking/causing damage Aggravated vehicle taking/causing injury Attempting to drive while unfit from drink/drugs Attempting to drive with excess alcohol in blood Attempting to drive with excess alcohol in breath Attempting to drive with excess alcohol in urine Breach of traffic sign Careless Driving Carrying unauthorised passenger on motorcycle Causing an accident with defective braking system Causing an accident with defective steering Causing an accident with no driving licence Causing death by inconsiderate driving when unfit Causing death by inconsiderate driving with excess alcohol Child under 12/135cm no restraints Child under 14 no seat belt Dangerous driving Death by careless driving providing no specimen Death by careless driving providing no specimen Death by careless driving when unfit Death by dangerous driving Death by inconsiderate driving no specimen Death by reckless driving Defective steering Defective tyre Defective tyres Driving a car with an unrestrained child under 12 Driving a vehicle and failing to notify disability Driving classified vehicle on sp road Driving not in control of vehicle Driving on a buslane on motorway Driving on hard shoulder motorway Driving under age Driving while disqualified Driving while disqualified until tested Driving while unfit drink/drugs Driving with excess alcohol in blood Driving with excess alcohol in urine Driving with no control of vehicle Driving with no view of road/traffic Driving without consideration for others Driving without due care/attention Exceed 45 MPH displaying R plates Exceed 45 MPH with L plates Exceed height of semi-trailer Exceed special speed limit Exceed temporary speed limit Excess alcohol Excess alcohol in breath Excess speed Excess speed drawing trailer Excess speed vehicle classification Failing to give correct name/address Failing to give driver information Failing to give info about owner Failing to give particulars-damage Failing to give passenger name/address Failing to obey signal by constable Failing to particulars injury only Failing to precedence zebra crossing Failing to precedence zebra crossing Failing to provide blood/urine sample Failing to provide preliminary breath test Failing to provide specimen breath analysis Failing to provide specimen excess alcohol Failing to remain at scene-damage Failing to remain at scene-injury Failing to report damage only accident Failing to report injury only accident Failing to set handbrake Failing to stop at pelican crossing Failing to stop for school crossing patrol Failing to stop-injury accident Failing to stop-injury accident Failing to wear seat belt-driver Furious driving GBH by dangerous driving GBI by driving car while seriously unfit GBI by inconsiderate driving when unfit GBI by inconsiderate driving with excess alcohol GBI careless driving/no specimen GBI driving car with excess alcohol GBI inconsiderate driving/no specimen Hold mobile phone while driving In charge of vehicle with excess alcohol in blood In charge of vehicle with excess alcohol in breath In charge of vehicle with excess alcohol in urine L driver carrying passenger on motorcycle L driver on motocycle over 250cc L driver on motocycle over 250cc Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No specimen/ attempting to drive with excess alcohol No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/in charge of a vehicle whilst unfit On hard shoulder longer than necessary On hard shoulder longer than necessary Overtaking moving vehicle at zebra crossing Overtaking stationary vehicle at zebra crossing Parked on clearway - AM Parked on clearway - AM Parked on clearway - PM Parked on footway adjacent to clearway Parked on hard shoulder motorway Parked within limits of pelican crossing Parked within limits of zebra crossing Parking in dangerous position Parking within 15M of junction Parking within 15M of junction Parking within 15M of junction Refusing eyesight test Refusing eyesight test Reversing from minor road to main road Reversing from minor road to main road Stop on approach to pelican crossing Stop within limit of zebra area Stop within limit of zebra area Typres insufficient for axle wght Typres insufficient for axle wght Unaccompanied HGV L driver(GCV/PCV) Unaccompanied L driver Unaccompanied L driver (GCV/PCV) Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Using goods vehicle in dangerous cont Using mobile phone while driving Using passenger vehicle in dangerous cont Using passenger vehicle in dangerous cont Using veh with defect brakes Using vehicle in dangerous condition Using vehicle not insured for TP Using vehicle without cert of roadworthy

-- Not selected -- 1 2 3 4 5 6 7 8 9 10 11 12

/ /

-- Not selected -- Aggravated vehicle taking/causing damage Aggravated vehicle taking/causing injury Attempting to drive while unfit from drink/drugs Attempting to drive with excess alcohol in blood Attempting to drive with excess alcohol in breath Attempting to drive with excess alcohol in urine Breach of traffic sign Careless Driving Carrying unauthorised passenger on motorcycle Causing an accident with defective braking system Causing an accident with defective steering Causing an accident with no driving licence Causing death by inconsiderate driving when unfit Causing death by inconsiderate driving with excess alcohol Child under 12/135cm no restraints Child under 14 no seat belt Dangerous driving Death by careless driving providing no specimen Death by careless driving providing no specimen Death by careless driving when unfit Death by dangerous driving Death by inconsiderate driving no specimen Death by reckless driving Defective steering Defective tyre Defective tyres Driving a car with an unrestrained child under 12 Driving a vehicle and failing to notify disability Driving classified vehicle on sp road Driving not in control of vehicle Driving on a buslane on motorway Driving on hard shoulder motorway Driving under age Driving while disqualified Driving while disqualified until tested Driving while unfit drink/drugs Driving with excess alcohol in blood Driving with excess alcohol in urine Driving with no control of vehicle Driving with no view of road/traffic Driving without consideration for others Driving without due care/attention Exceed 45 MPH displaying R plates Exceed 45 MPH with L plates Exceed height of semi-trailer Exceed special speed limit Exceed temporary speed limit Excess alcohol Excess alcohol in breath Excess speed Excess speed drawing trailer Excess speed vehicle classification Failing to give correct name/address Failing to give driver information Failing to give info about owner Failing to give particulars-damage Failing to give passenger name/address Failing to obey signal by constable Failing to particulars injury only Failing to precedence zebra crossing Failing to precedence zebra crossing Failing to provide blood/urine sample Failing to provide preliminary breath test Failing to provide specimen breath analysis Failing to provide specimen excess alcohol Failing to remain at scene-damage Failing to remain at scene-injury Failing to report damage only accident Failing to report injury only accident Failing to set handbrake Failing to stop at pelican crossing Failing to stop for school crossing patrol Failing to stop-injury accident Failing to stop-injury accident Failing to wear seat belt-driver Furious driving GBH by dangerous driving GBI by driving car while seriously unfit GBI by inconsiderate driving when unfit GBI by inconsiderate driving with excess alcohol GBI careless driving/no specimen GBI driving car with excess alcohol GBI inconsiderate driving/no specimen Hold mobile phone while driving In charge of vehicle with excess alcohol in blood In charge of vehicle with excess alcohol in breath In charge of vehicle with excess alcohol in urine L driver carrying passenger on motorcycle L driver on motocycle over 250cc L driver on motocycle over 250cc Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No specimen/ attempting to drive with excess alcohol No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/in charge of a vehicle whilst unfit On hard shoulder longer than necessary On hard shoulder longer than necessary Overtaking moving vehicle at zebra crossing Overtaking stationary vehicle at zebra crossing Parked on clearway - AM Parked on clearway - AM Parked on clearway - PM Parked on footway adjacent to clearway Parked on hard shoulder motorway Parked within limits of pelican crossing Parked within limits of zebra crossing Parking in dangerous position Parking within 15M of junction Parking within 15M of junction Parking within 15M of junction Refusing eyesight test Refusing eyesight test Reversing from minor road to main road Reversing from minor road to main road Stop on approach to pelican crossing Stop within limit of zebra area Stop within limit of zebra area Typres insufficient for axle wght Typres insufficient for axle wght Unaccompanied HGV L driver(GCV/PCV) Unaccompanied L driver Unaccompanied L driver (GCV/PCV) Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Using goods vehicle in dangerous cont Using mobile phone while driving Using passenger vehicle in dangerous cont Using passenger vehicle in dangerous cont Using veh with defect brakes Using vehicle in dangerous condition Using vehicle not insured for TP Using vehicle without cert of roadworthy

-- Not selected -- 1 2 3 4 5 6 7 8 9 10 11 12

/ /

-- Not selected -- Aggravated vehicle taking/causing damage Aggravated vehicle taking/causing injury Attempting to drive while unfit from drink/drugs Attempting to drive with excess alcohol in blood Attempting to drive with excess alcohol in breath Attempting to drive with excess alcohol in urine Breach of traffic sign Careless Driving Carrying unauthorised passenger on motorcycle Causing an accident with defective braking system Causing an accident with defective steering Causing an accident with no driving licence Causing death by inconsiderate driving when unfit Causing death by inconsiderate driving with excess alcohol Child under 12/135cm no restraints Child under 14 no seat belt Dangerous driving Death by careless driving providing no specimen Death by careless driving providing no specimen Death by careless driving when unfit Death by dangerous driving Death by inconsiderate driving no specimen Death by reckless driving Defective steering Defective tyre Defective tyres Driving a car with an unrestrained child under 12 Driving a vehicle and failing to notify disability Driving classified vehicle on sp road Driving not in control of vehicle Driving on a buslane on motorway Driving on hard shoulder motorway Driving under age Driving while disqualified Driving while disqualified until tested Driving while unfit drink/drugs Driving with excess alcohol in blood Driving with excess alcohol in urine Driving with no control of vehicle Driving with no view of road/traffic Driving without consideration for others Driving without due care/attention Exceed 45 MPH displaying R plates Exceed 45 MPH with L plates Exceed height of semi-trailer Exceed special speed limit Exceed temporary speed limit Excess alcohol Excess alcohol in breath Excess speed Excess speed drawing trailer Excess speed vehicle classification Failing to give correct name/address Failing to give driver information Failing to give info about owner Failing to give particulars-damage Failing to give passenger name/address Failing to obey signal by constable Failing to particulars injury only Failing to precedence zebra crossing Failing to precedence zebra crossing Failing to provide blood/urine sample Failing to provide preliminary breath test Failing to provide specimen breath analysis Failing to provide specimen excess alcohol Failing to remain at scene-damage Failing to remain at scene-injury Failing to report damage only accident Failing to report injury only accident Failing to set handbrake Failing to stop at pelican crossing Failing to stop for school crossing patrol Failing to stop-injury accident Failing to stop-injury accident Failing to wear seat belt-driver Furious driving GBH by dangerous driving GBI by driving car while seriously unfit GBI by inconsiderate driving when unfit GBI by inconsiderate driving with excess alcohol GBI careless driving/no specimen GBI driving car with excess alcohol GBI inconsiderate driving/no specimen Hold mobile phone while driving In charge of vehicle with excess alcohol in blood In charge of vehicle with excess alcohol in breath In charge of vehicle with excess alcohol in urine L driver carrying passenger on motorcycle L driver on motocycle over 250cc L driver on motocycle over 250cc Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position Leaving vehicle in dangerous position No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No prescribed braking system No specimen/ attempting to drive with excess alcohol No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/attempting to drive while unfit No specimen/in charge of a vehicle whilst unfit On hard shoulder longer than necessary On hard shoulder longer than necessary Overtaking moving vehicle at zebra crossing Overtaking stationary vehicle at zebra crossing Parked on clearway - AM Parked on clearway - AM Parked on clearway - PM Parked on footway adjacent to clearway Parked on hard shoulder motorway Parked within limits of pelican crossing Parked within limits of zebra crossing Parking in dangerous position Parking within 15M of junction Parking within 15M of junction Parking within 15M of junction Refusing eyesight test Refusing eyesight test Reversing from minor road to main road Reversing from minor road to main road Stop on approach to pelican crossing Stop within limit of zebra area Stop within limit of zebra area Typres insufficient for axle wght Typres insufficient for axle wght Unaccompanied HGV L driver(GCV/PCV) Unaccompanied L driver Unaccompanied L driver (GCV/PCV) Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Unlawful use of central reservation on motorway Using goods vehicle in dangerous cont Using mobile phone while driving Using passenger vehicle in dangerous cont Using passenger vehicle in dangerous cont Using veh with defect brakes Using vehicle in dangerous condition Using vehicle not insured for TP Using vehicle without cert of roadworthy

-- Not selected -- 1 2 3 4 5 6 7 8 9 10 11 12

/ /

Please enter Date Points Received in DD/MM/YYYY format. Sum of penalty points selected must match with the total penalty points selected. Please select valid data for nature of offence and date points received (DD/MM/YYYY).

Car Details

Do you know the car registration?*

Yes No

Car cannot be more than 15 years old.

Vehicle Registration Number*

Find Car

Please use format:ABC1234. Vehicle Registration Number should be entered.

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Please confirm this is the correct vehicle*

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Sorry, we can't find your car.Please check the Registration Number you entered is correct, or select No above to enter your car details manually.

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Car Manufacturer*

-- Please select -- AC AIXAM ALFA ROMEO ASIA ASTON MARTIN AUDI AUSTIN BEDFORD BENTLEY BMW BOND BRISTOL BUGATTI BUICK CADILLAC CARBODY CATERHAM CHEVROLET CHRYSLER CHRYSLER JEEP CITROEN DACIA DAEWOO DAIHATSU DAIMLER DALLAS DATSUN DAX DE TOMASO DELICA DODGE FAIRWAY FERRARI FIAT FORD FORD (AUS) FORD (USA) FORD IVECO FSO GINETTA HINDUSTAN HOLDEN HONDA HUMMER HYUNDAI ISUZU JAGO JAGUAR JEEP KIA KUBOTA LADA LAMBORGHINI LANCIA LAND ROVER LANDROVER LEXUS LEXUS (USA) LEYLAND LIGIER LOTUS MAHINDRA MARCOS MARLIN MASERATI MAYBACH MAZDA MERCEDES MERCEDES-BENZ MG MICROCAR MINI MITSUBISHI MORGAN NISSAN OLDSMOBILE OPEL PANTHER PATHFINDER PERODUA PEUGEOT PONTIAC PORSCHE PORTARO PROTON RENAULT ROLLS ROYCE ROVER SAAB SANTANA SAO SATURN SEAT SHELBY SKODA SMART SSANGYONG SUBARU SUZUKI TALBOT TATA TOYOTA TRABANT TRIUMPH TVR VAUXHALL VOLKSWAGEN VOLVO WARTBURG WESTFIELD YUGO/ZASTAVA

Click the dropdown list and type the first letter of your Manufacturer.

Engine Size*

-- Please select -- Below 1.0 Litre 1.0 Litre 1.1 Litre 1.2 Litre 1.3 Litre 1.4 Litre 1.5 Litre 1.6 Litre 1.7 Litre 1.8 Litre 1.9 Litre 2.0 Litre 2.1 Litre 2.2 Litre 2.3 Litre 2.4 Litre 2.5 Litre 2.6 Litre 2.7 Litre 2.8 Litre 2.9 Litre 3.0 Litre 3.1 Litre 3.2 Litre 3.3 Litre 3.4 Litre 3.5 Litre 3.6 Litre 3.7 Litre 3.8 Litre 3.9 Litre 4.0 Litre 4.1 Litre 4.2 Litre 4.3 Litre 4.4 Litre 4.5 Litre 4.6 Litre 4.7 Litre 4.8 Litre

If you are unsure of the cubic capacity of your car you should refer to your vehicle registration certificate.

Year of Manufacture*

-- Please select -- 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974

Model*

-- Please select --

Select your car from this list. If you cannot find an exact match then please call us.

Do you require Trailer Cover?*

Yes No

Third Party cover to tow a Trailer/Horsebox is automatically included in your policy but in addition you can also cover for loss of or accidental damage.

Trailer Value

-- Please select -- £500 £1,000 £1,500 £2,000 £2,500 £3,000 £3,500 £4,000 £4,500 £5,000 £5,500 £6,000 £6,500 £7,000 £7,500 £8,000 £8,500 £9,000 £9,500 £10,000

Trailer year of manufacture

-- Please select -- 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974

Trailer Make/Model Description

Additional Security*

-- Please select -- Alarm Immobiliser None

Vehicle Value*

-- Please select -- less than £1,000 £1,001 - £2,000 £2,001 - £3,000 £3,001 - £4,000 £4,001 - £5,000 £5,001 - £6,000 £6,001 - £7,000 £7,001 - £8,000 £8,001 - £9,000 £9,001 - £10,000 £10,001 - £11,000 £11,001 - £12,000 £12,001 - £13,000 £13,001 - £14,000 £14,001 - £15,000 £15,001 - £16,000 £16,001 - £17,000 £17,001 - £18,000 £18,001 - £19,000 £19,001 - £20,000 £20,001 - £21,000 £21,001 - £22,000 £22,001 - £23,000 £23,001 - £24,000 £24,001 - £25,000 £25,001 - £26,000 £26,001 - £27,000 £27,001 - £28,000 £28,001 - £29,000 £29,001 - £30,000 £30,001 - £31,000 £31,001 - £32,000 £32,001 - £33,000 £33,001 - £34,000 £34,001 - £35,000 £35,001 - £36,000 £36,001 - £37,000 £37,001 - £38,000 £38,001 - £39,000 £39,001 - £40,000 £40,001 - £41,000 £41,001 - £42,000 £42,001 - £43,000 £43,001 - £44,000 £44,001 - £45,000 £45,001 - £46,000 £46,001 - £47,000 £47,001 - £48,000 £48,001 - £49,000 £49,001 - £50,000 £50,001 - £51,000 £51,001 - £52,000 £52,001 - £53,000 £53,001 - £54,000 £54,001 - £55,000 £55,001 - £56,000 £56,001 - £57,000 £57,001 - £58,000 £58,001 - £59,000 £59,001 - £60,000

Use Of Car

Your quotation will include cover for social, domestic and pleasure use (including driving to and from work).

Do you use your car in connection with your business / profession / occupation?*

Yes No

If you are in doubt, select Yes and answer the additional question that appear below

Limited Business Use for Yourself Only*

Yes No

This excludes use for soliciting orders, carrying goods/samples or commercial travelling.

Limited Business Use for You and Your Partner*

Yes No

This excludes use for soliciting orders, carrying goods/samples or commercial travelling.

Discounts

Member of Institute of Advanced Motorists*

Yes No

Years No Claim Bonus Earned (in your own name)*

-- Please select -- 0 Years 1 Years 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years or more

We will need proof of your No Claims Bonus. Please select the number of years No Claims Bonus earned in your own name, as advised by your last insurer. If your No Claims Bonus is capped at 5 years please enter the number of years you have been driving claims free. Note that this experience must have been earned in the last 2 years. Experience earned as a named driver is not applicable to this question. If your no claim bonus is not from the EU please call us.
Please see our Assumptions for more information.

Does your partner currently have full-time use of a Private car*

Yes No

Do you know your partner car registration?*

Yes No

Discounts may be available if this is the second car in your family(this includes full-time use of a company car but excludes commercial vehicles e.g. car vanettes, vans, taxis etc).

Vehicle Registration Number*

Find Car

Vehicle Registration Number should be entered.

Is this your car?

Please confirm this is the correct vehicle*

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Sorry, we can't find your car.Please check the Registration Number you entered is correct, or select No above to enter your car details manually.

Car Manufacturer*

-- Please select -- AC AIXAM ALFA ROMEO ASIA ASTON MARTIN AUDI AUSTIN BEDFORD BENTLEY BMW BOND BRISTOL BUGATTI BUICK CADILLAC CARBODY CATERHAM CHEVROLET CHRYSLER CHRYSLER JEEP CITROEN DACIA DAEWOO DAIHATSU DAIMLER DALLAS DATSUN DAX DE TOMASO DELICA DODGE FAIRWAY FERRARI FIAT FORD FORD (AUS) FORD (USA) FORD IVECO FSO GINETTA HINDUSTAN HOLDEN HONDA HUMMER HYUNDAI ISUZU JAGO JAGUAR JEEP KIA KUBOTA LADA LAMBORGHINI LANCIA LAND ROVER LANDROVER LEXUS LEXUS (USA) LEYLAND LIGIER LOTUS MAHINDRA MARCOS MARLIN MASERATI MAYBACH MAZDA MERCEDES MERCEDES-BENZ MG MICROCAR MINI MITSUBISHI MORGAN NISSAN OLDSMOBILE OPEL PANTHER PATHFINDER PERODUA PEUGEOT PONTIAC PORSCHE PORTARO PROTON RENAULT ROLLS ROYCE ROVER SAAB SANTANA SAO SATURN SEAT SHELBY SKODA SMART SSANGYONG SUBARU SUZUKI TALBOT TATA TOYOTA TRABANT TRIUMPH TVR VAUXHALL VOLKSWAGEN VOLVO WARTBURG WESTFIELD YUGO/ZASTAVA

Engine Size*

-- Please select -- Below 1.0 Litre 1.0 Litre 1.1 Litre 1.2 Litre 1.3 Litre 1.4 Litre 1.5 Litre 1.6 Litre 1.7 Litre 1.8 Litre 1.9 Litre 2.0 Litre 2.1 Litre 2.2 Litre 2.3 Litre 2.4 Litre 2.5 Litre 2.6 Litre 2.7 Litre 2.8 Litre 2.9 Litre 3.0 Litre 3.1 Litre 3.2 Litre 3.3 Litre 3.4 Litre 3.5 Litre 3.6 Litre 3.7 Litre 3.8 Litre 3.9 Litre 4.0 Litre 4.1 Litre 4.2 Litre 4.3 Litre 4.4 Litre 4.5 Litre 4.6 Litre 4.7 Litre 4.8 Litre

Year of Manufacture*

-- Please select -- 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974

Model*

-- Please select --

Is the annual mileage of the proposer's car detailed in 'Your Car Details' section above, greater than 15,000 kilometres?*

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This is annual mileage of the proposer's car if it is greater than 15,000 kilometres.

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