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Commercial Vehicle Quotation

For a free quotation on commercial vehicle insurance please complete the short form below.  One of our advisors will contact you via your preferred method with your quotation.

To make sure you get our best deal and to ascertain the most appropriate payment options for you and to protect you from fraud, we use public and personal data from a variety of sources, including a credit reference agency and other organisations. Our search will appear on your credit report whether or not your application proceeds. By continuing you agree to these uses of your information.

If the vehicle is to be insured in the name of a company, please state the full name of the company here
Personal Details  
Title  
Forename  
Surname  
Date of Birth                 
Occupation  
   
Communication Address  
House Name/Number                  
Street   
Town
City
County
Postcode  
   
Contact Details  
Home Telephone Number
Work Telephone Number
Mobile Telephone Number
Email Address  
Preferred Method of Contact    
   
Vehicle Details  
Registration Number  
Make  
Model  
Engine Size  
Gross Vehicle Weight  
Carrying Capacity  
Category  
Fuel Type  
Value  
Where is the vehicle kept overnight?  
   
Cover Details  
What cover do you require?  
What will the vehicle be used for?  
Who will be driving the vehicle?  
Are you entitled to any No Claims Discount for use on this vehicle? Yes No
Do you require No Claims Bonus Protection? Yes No
When do you require cover from?  
Drivers Details
Full Name Full Name Date of Birth Relationship to proposer Occupation Licence Type Date Passed Test
Proposer          
Driver 2
Driver 3
Driver 4
Accident/Claims History  
Have any of the above been involved in any accidents or suffered any losses within the last 5 years? Yes No
(If yes, please give details below)  
Driver Name Incident Date Incident Description Own Cost (£) Third Party Cost (£) Fault / Non-Fault
   
   
   
   
Conviction History  
Have any of the drivers been convicted of any motoring offences within the last 5 years or ever been banned from driving? Yes No
(If yes, please give details below)  
Driver Name Conviction Code Date of Conviction Date of Offence Fine (£) Penalty Points Disqualification Period
         
         
         
         
Legal

I/We understand that where the insurance requires supply of information relating to other persons who may be insured under the contract, that the information must be factual and accurate to enable correct assessment of risk by the insurer. I confirm that I have the consent of these individuals to supply their personal details to the insurer.
For the purposes of the Data Protection Act 1998 the data controller in relation to any personal data you supply is Cox Braithwaite Insurance Brokers.
 I/we understand that the information I/we supply may be used by Cox Braithwaite Insurance Brokers to keep me informed by post, telephone, e-mail or other means about products and services which may be of interest to me. Please note that your information may also be used for these purposes after your policy has lapsed. If you do not wish your information to be used for marketing purposes, please tick this box
Your quotation will be based on the information you have provided above and this information will form the basis of your policy if you decide to buy, please check the information you have entered.

 
  Contact Us
General & Professional Insurance Brokers Ltd t/a Cox Braithwaite Insurance Brokers
Park House
Greyfriars Road
Cardiff, CF10 3AF

Telephone: 0800 975 3322
Fax: 029 2037 3687

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Company Registration No. 1535804

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General & Professional Insurance Brokers Ltd t/a Cox Braithwaite Insurance Brokers are Authorised & Regulated by the Financial Services Authority