Farm Fleet Insurance Cornwall

Broker*

Your Telephone*

Your Email*

Address*

Current Insurer*

Renewal Date

Deadline Date

Target (£)*

General Questions

Do You Own Any Motor Vehicles Other Than Those Declared?*
YesNo

Has Any Vehicle Been Modified From The Manufacturers Standard Specification?*
YesNo

Will Any Vehicle Be Kept At Any Address Other Than That Shown Above?
YesNo

Are Any Vehicles Not Registered In Your Name?*
YesNo

Do You Require Driving To Be Restricted For Any Of The Vehicles?*
YesNo

Will Any Driver Under The Age Of 25 Be The Main User Of Any Vehicles?*
YesNo

Will Any Vehicle Be used For Any Purpose Other Than SD & P Or Farm/Estate Use?*
YesNo

Will Any Good Carrying Vehicles Be Used For Journeys In Excess Of A 100 Mile Radius Of Base?*
YesNo

Will Any Goods Carrying Vehicles Be Used For Carriage Of Goods For Hire Or Reward?*
YesNo

Will Any Agricultural Vehicle Be Used For Agricultural Contracting/Tree Felling/Haulage?*
YesNo

If 'Yes' To Any Of The Above, Please Provide Full Details:

Private Motor Vehicles - Schedule

£100 Fire, Theft, Malicious & Accidental Damage Excess Applies To All Vehicles In Addition To Any Other Terms Applicable.

Make & Model Of Vehicle

Year Of Manufacturer

Engine CC

Vehicle Value (£)

Vehicle Registration Number

Cover

No Claims Bonus

Main Drivers Date Of Birth

Add A 2nd Vehicle?
Yes
 

Commercial Motor Vehicles - Schedule

£100 Fire, Theft, Malicious & Accidental Damage Excess Applies To All Vehicles In Addition To Any Other Terms Applicable.

Make & Model Of Vehicle

Year Of Manufacturer

Gross Vehicle Weight

Vehicle Value (£)

Vehicle Registration Number

Cover

No Claims Bonus

Main Drivers Date Of Birth

Add A 2nd Vehicle?
Yes
 

Agricultural Motor Vehicles - Schedule

Excludes Third Party Working Risk. Includes £30,000 Trailer Implement Cover When All Vehicles Are On Comprehensive Cover.

Make & Model Of Vehicle

Year Of Manufacturer

Vehicle Value (£)

Vehicle Registration Number/ID Number

Cover

No Claims Bonus

Add A 2nd Vehicle?
Yes
 

Driving Restrictions Required

Private Motor Vehicles

Commercial Motor Vehicles

Driver Details

Full Name

Date Of Birth

Occupation

License Type

Date Of UK Test

Add A 2nd Driver?
Yes
 

Driver History

Have You Or Any Person Who May Drive (Including Those Detailed Above):
Been Refused Insurance Or Had A Policy Cancelled Or Ever Special Terms Imposed?
YesNo

Suffered From Any Medical Condition?
YesNo

 
Had Any Convictions Within The Last 5 Years, Or Any Prosecutions That Are Pending?
YesNo

Been Disqualified From Driving Or Had A License Suspended Or Revoked?
YesNo

 
Had Any Accidents, Claims Or Losses During The Last Three Years, Fault Or Non-Fault?
YesNo

 
Additional Information

 
We need to store your personal details so we can respond to you. For more information please read our privacy policy.
Can We Store Your Data For Future Use? (Your Data Will Not Be shared)
YesNo