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Motorcycle Insurance Quotation Form
 
  Proposer Details
Surname
First Name
Title
Sex
Status
Postcode
House Number
Address
Tel
Mobile
Email Address
Home owner?
DOB
Licence type
How long held?
CBT Pass Rate
How many Continuous years riding experience ?
How many years motorcycle ?
How many years UK Resident
Largest CC in last 5 years
Cover Required
Occupation Full / P. Time
Full Time or Part Time
Inception Date
 
 
  Bike Details
Make
Model
Year
Value
Purchased Date
Is the bike kept in a locked bricked / concrete building overnight at the home address
Any alarm or immobiliser fitted.
Make & model
Type of tagging devices fitted
Make and model of physcial security used
Please list any modifications
Have you or any name rider suffered any accidents, claims or losses within the last 5 years in any vehicle
Riders Name Type Date Cost
Have you or any named rider suffered any convictions in the last 5 years or disqualifications in the last 11 years.
Riders Name Code No. of Points Date Cost
Have you or any named drivers any disabilities or medical conditions
Riders Name Disability DVLA Advised
Have you or any named drivers completed any training schemes
Riders Name Scheme
  Additional Question
Are you a full member of BMF or MAG?
Target Price?
 
 
   Additional Rider
Surname
First Name
Title
Sex
Status
Relationship
DOB
Licence type
How long held?
CBT Passed
Date Passed
How many continuous riding experience
Occupation Full / P. Time
Full Time or Part Time
 
 
   Miscellanceous
Yes No
Will any rider carry pillions?
Is the owner the registered keeper?
Maximum annual millage
Use
   
   
 
 
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