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0333 3580 300
team@abilitydrive.co.uk
Home
About Us
FAQ
Other Covers
Motor Legal Expenses
Excess protect
GAP Insurance
Breakdown Cover
Contact Us
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Client Details and General Information
Answer the questions you can but do not worry if you do not have all the answers. Just submit what you can and we can come back to you to work together to complete them.
Name
*
First
Last
Email
*
Phone
*
Address
*
Period of Insurance
Effective Date
Vehicle
Cover basis
Comprehensive
TPF&T
TPO
Registration number
Vehicle make/model
Overnight parking postcode
Overnight parking
Roadside
Driveway
Garaged
Car Park
Year first registered (yyyy)
Purchase date of vehicle
Value (£)
Vehicle body type
Number of seats
Number of seats
Vehicle annual private mileage
Vehicle annual business mileage
Modified
Type of modification
Modification due to medical condition
Vehicle registered keeper
Yes
No
Vehicle owner
Yes
No
Previously insured
Yes
No
Previous insurer
Claimed previous insurer
Yes
No
NCB years
1
2
3
4
5
6
7+
Protected NCB requested
Yes
No
NCB type (If N/A, use Private Car Bonus)
Private
Company Car
None
Drivers
We need to ascertain number of drivers, then get the prospect to complete the following for each of the drivers. First one should always default to proposer: -
Relationship to proposer
Proposer
Spouse
Friend
Family
Carer
Class of use
Driver title
Mr
Mrs
Miss
Dr
Other
Drivers Name
First
Last
Driver date of birth
Years resident in UK
Years resident in UK
Driver gender
Driver marital status
Single
Married
Third Choice
Divorced
Seperated
Driver licence type
Driver licence valid from
Number of other vehicles driven
Driver occupation
Medical condition notifiable to the DVLA
Have any of these conditions caused the driver's licence to be restricted?
Comments
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