Tree Surgery Insurance, Arboricultural Insurance, Tree Surgeon Liability Insurance, Commercial Vehicle Insurance, Fleet Insurance

Aborist Commercial Vehicle Insurance

The completion of this form in no way binds the Proposer to purchase insurance, nor does it bind Underwriters to give insurance.

Any information given will only be passed to Underwriters for the purpose of quotation and will be treated as confidential.

Title

Surname

First Names

Telephone Number:

Address

Postcode

Email Address

How long have you been resident at the above address?

Commencement of cover

Date of Birth

Is this vehicle kept in a garage overnight?

Yes	No

When not in use where is the vehicle kept during a normal working day?

Occupation (including any part time jobs)

State Nature of Business

Are you married?

Yes	No

Are you the legal owner of the vehicle?

Yes	No

Is the vehicle registered in your name?

Yes	No

Are you the main driver of the vehicle?

Yes	No

Is the vehicle leased?

Yes	No

Do you own or have use of any other vehicles e.g. Company car etc.

Yes	No

Type of licence currently held

State period held

Years Months

Date of residency in UK

Postcode of business from which vehicle will operate

Who will drive?

Yourself	You and Spouse only	Named Drivers

Driver details:

Please list all persons who may drive including spouse (Note. Increased excess will apply to all drivers under 25)

Additional Driver 1

Name

Date of Birth

Occupation

Type of licence and period held

Use of another car

Yes	No

Additional Driver 2

Name

Date of Birth

Occupation

Type of licence and period held

Use of another car

Yes	No

Additional Driver 3

Name

Date of Birth

Occupation

Type of licence and period held

Use of another car

Yes	No

State whether you or any person who may drive including those listed above:

Suffer from diabetes, fits, heart condition, loss of eye or limb or any physical/mental/alcoholic condition

Yes	No

Have been convicted of any motoring offence (including fixed penalty offences) during the last 5 years or is any police enquiry or prosecution pending

Yes	No

Please give details:

have been convicted of any non motoring offence

Yes	No

Have been disqualified from holding or obtaining a driving licence

Yes	No

Have been involved in any accident or loss of any kind (including thefts) in connection with any motor vehicle within last 5 years

Yes	No

Please give details:

Have been refused motor insurance at normal terms or had a motor policy cancelled

Yes	No

Details of any of the above:

Vehicle Details

Make and Model

Type of Body (Tipper/Refridgerated etc.)

Registration Number

Year

Engine Size

Value

Date of Purchase

Is Vehicle Left hand drive?

Yes	No

Is it normally kept at the above address?

Yes	No

Has the vehicle been modified to change the makers standard specification or alter its performance?
This includes cosmetic changes, e.g. body kits, alloy wheels, additional seats, fixtures & fittings and signwriting etc. If Yes please give details

Is the vehicle fitted with any of the following

Thatcham 1 immobiliser

Yes	No

Thatcham 2 immobiliser

Yes	No

Non Thatcham Alarm or Immobiliser

Yes	No

Tracking Device

Yes	No

Does the vehicle registration document show that the vehicle has been imported from a country outside the european union.

Yes	No

Cover Required

Comprehensive

Third Party Fire & Theft

Third Party only

If you require a voluntary accidental damage fire and theft excess please indicate the amount in the box provided (other compulsory excess may apply)

IDo you wish to limit your mileage to qualify for a premium discount

Yes	No

If yes please state current mileage reading of vehicle

And anticipated annual mileage

USE

Carriage of own goods only

Yes	No

Carriage of goods for hire and reward within 100 mile radius

Yes	No

Carriage of goods for hire and reward without radius restriction

Yes	No

Will goods of an inflammable, explosive, corrosive or dangerous nature be carried at any time

Yes	No

No claims discount

Number of Years

I/Wer declare that the answers given above (on which the insurer will rely in deciding whther to accept the risk and in fixing the premium) are true to the best of my knowledge and belief, and that no information has been withheld by me/us that might influence the insurers' acceptance and assessment of this insurance, and I/We agree to accept a policy subject to the terms, conditions and exceptions contained therein. I/We understand that you will pass the information on this form and about any incident I/We may give details of to the ABI so that they can make it available to other insurers. I/We also understand that, in response to any searches you may make in connection with this application or any incident I/We have given details of, the ABI may pass you information it has received from other insurers about other incidents anyone insured to drive the vehicle covered under the policy have been involved in".

Please tick box to accept

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