Chauffeur Quote Request

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Please Answer The Questions Below To Request A Quotation For Your Chauffeur Insurance

Please Answer Every Question As Accurately As Possible As Incorrect Information Or Omissions Could Lead To A Policy Being Made Void And Claims Not Being Paid.

If want to complete this form from a mobile PLEASE TURN TO LANDSCAPE.

If You Hate Filling Online Forms And Prefer To Speak To An Adviser, Please Phone Us On 0115 9455447.

Thank You
The Team At AC Insurance.

Your full name *

Renewal Date or Start Date Required *

YYYY

Date of Birth *

YYYY

Trading Name (Please advise if a limited company)

Contact Telephone Number *

Email Address *

Website Address

Home or Correspondence Address *

First line of address, where vehicles are kept overnight? if different from above

How are vehicles stored overnight? *

Garaged

Driveway

Secure Storage

On Public Road

How many years have you been trading? *

0 New Start Up

How are your vehicles currently insured? *

Fleet

Single Vehicle Policy

New Start Up

Are you an NLCA member?

Yes

Joining

Clear selection

Vehicle 1 - Please provide Make/Model/Year/Value/Number of Passengers and Number of years available No Claims Bonus *

Vehicle 2 - Please provide Make/Model/Year/Value/Number of Passengers and Number of years available No Claims Bonus

Vehicle 3 - Please provide Make/Model/Year/Value/Number of Passengers and Number of years available No Claims Bonus

Vehicle 4 - Please provide Make/Model/Year/Value/Number of Passengers and Number of years available No Claims Bonus

Vehicle 5 - Please provide Make/Model/Year/Value/Number of Passengers and Number of years available No Claims Bonus

Are all jobs pre booked and paid for with no money being exchanged in the vehicle? *

Yes

How are your vehicles licenced? *

PSV Restricted

PSV National

Local Authority Licenced

Not Licenced - Weddings Only - 3000 Miles per year

Not Licenced - Weddings Only - 5000 Miles per year

Not Licenced - Weddings and Funeral use

Not Licenced - Funerals Only

Other:

Do all vehicles over 8 passengers have a valid COIF certificate? *

Yes

N/A

Driving restriction required? *

Insured Only

Insured and named drivers

Any driver 25 to 70

Other:

Will any vehicle be used in connection with self drive hire (vehicle driven by hirer of vehicle) *

Yes

Please advise any involvement you have ever had in the self drive industry *

Can you confirm that no driver or proposer has ever had insurance refused, cancelled, terms imposed, have no unspent criminal convictions, CCJ's or Bankruptcies? *

Yes

If Yes - Please provide full details

Have you had any claims in the last 5 years? *

Yes

If Yes - Please give details of all claims (fault or not) within the last 5 years!

Do you, or any required driver have any Motoring Convictions in the last 5 years? *

Yes

If Yes - Please give details of all convictions (Date, Conviction Code, Points)

Is there any other information you would like to offer to assist with providing you with a quote or which you feel is significant to the quote? *

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