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| Welcome to Emsons Motor Trade Road Risks Quotation Form |
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Please note this form is for submitting details of your insurance risk to us. It does not in turn provide you with any automatic quotation or any cover.
Any quotation that we subsequently offer on the basis of information that you have supplied will be confirmed to you by post or telephone. NO COVER will be in force unless we notify you.
We may require additional information from you in order to prepare a quotation in which case you will be notified in writing, by email or post.
Any quotation request you have submitted will be verified with you prior to any contract coming into force.
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| Please complete the sections as directed |
| There is a submit button at the end of the form to mail it to us. |
You can be sent a copy of the form by e-mail, but if you wish to print it before sending, please press CTRL + P before submitting the form.
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| (Note : This form has been designed with the smaller motor trader in mind. Larger risks are more likely to benefit from a bespoke quotation service in which Emsons specialise – please refer to the Client Solutions section of the site for further details.) |
Any quotation submitted to Emsons will be verified with the Client before any cover is granted or any liability to
pay any premium is incurred.
Any policy that this quotation form may apply to is written under UK Jurisdiction.
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| Section 1 - Personal Details : |
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| Name | |
| Risk Address: | |
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| Post Code : | |
| Date of Birth : | |
| Are you a full-time or part-time Motor Trader ? |
FullPart |
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| Please give a description of your exact motor trade activities | |
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| Do you undertake Motor Vehicle sales ? |
YesNo |
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| If you are part-time, what is your other occupation(s) ? | |
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| Section 2 - Cover Details : |
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| What cover do you require a quotation for ? |
ComprehensiveThird party fire theftThird party only |
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| Do you require to extend cover for motor cycles ? (Third Party Only) |
YesNo |
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| Do you require to extend cover for demonstration use of vehicle ? |
YesNo |
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| What is you current annual indemnity limit for vehicles ? |
500075001000015000Higher
Please state if higher
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| Please state number and type of vehicles currently held for sale | |
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| How many years claims bonus are you currently entitled to under your existing motor trade policy ? | |
| Has this bonus been earnt on a motor trade policy, or on a private car policy ? |
TradePrivate |
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| Section 3 - Own Vehicle Details : |
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| Do you have your own vehicle which you wish to insure under this policy? |
YesNo
If so, please state the make, model, year and value of the vehicle :
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| Section 4 - Details of Proposer : |
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| What type of licence do you have ? |
FullProvisionalnon-UK |
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| How many years have you held your licence for ? | |
| Do you require cover for social use for the vehicle, in addition to motor trade ? |
YesNo |
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| Have you had any accidents or convictions within the last 3 years ? |
YesNo
If so, please give details
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| Do you suffer from any disabilities ? |
YesNo
If so, please give details
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| Do you operate a recovery vehicle ? : |
YesNo |
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| Do you either repair or sell any vehicles in excess of 7.5 Tonnes ? |
YesNo |
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| How many additional drivers do you wish to insure |
0123 |
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| (if more than 3 please contact Emsons on 01883 620720) |
| Additional Driver Details - Driver 1 : |
| What type of licence do they have ? Full / provisional / non-UK |
FullProvisionalnon-UK |
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| How many years have they held their licence for ? | |
| Do they require social use for the vehicle, in addition to motor trade ? |
YesNo |
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| Have they had any accidents or convictions within the last 3 years ? If so, please give details | |
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| Are they a full time motor trader ? if not, please give details | |
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| Do they suffer from any disabilities ? If so, please give details | |
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| Additional Driver Details - Driver 2 : |
| What type of licence do they have ? Full / provisional / non-UK |
FullProvisionalnon-UK |
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| How many years have they held their licence for ? | |
| Do they require social use for the vehicle, in addition to motor trade ? |
YesNo |
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| Have they had any accidents or convictions within the last 3 years ? If so, please give details | |
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| Are they a full time motor trader ? if not, please give details | |
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| Do they suffer from any disabilities ? If so, please give details | |
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| Additional Driver Details - Driver 3 : |
| What type of licence do they have ? Full / provisional / non-UK |
FullProvisionalnon-UK |
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| How many years have they held their licence for ? | |
| Do they require social use for the vehicle, in addition to motor trade ? |
YesNo |
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| Have they had any accidents or convictions within the last 3 years ? If so, please give details | |
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| Are they a full time motor trader ? if not, please give details | |
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| Do they suffer from any disabilities ? If so, please give details | |
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| Any further information you would like to submit as part of your proposal : | |
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| You will be forwarded a copy of this form by e-mail. Please enter your address below |
| E-mail address | |
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| IMPORTANT : You must have read and accepted the terms and conditions of
the Declaration that accompanies this proposal - click here to view the
terms - CLICK
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| Have you read and understood the terms of the Declaration? |
Yes
No |
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| IMPORTANT : You must have read and accepted the terms and conditions of
the Data Protection clause that accompanies this proposal - click here to view the
terms - CLICK
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| Have you read and understood the terms of the Declaration? |
Yes
No |
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