Motorhome Insurance & Campervan Insurance Instant Online Quotation

YOUR DETAILS

Title First Name Surname

Email Address

Confirm Email Address:

Post Code

Address

Post Code

Employment Status

Is your business or the business of your employer connected in any way with the list below.

Amusement Arcade Owner/Employee
Artist
Caravan Dweller
Casino Employee
Doorman/Bouncer/Night Security
Entertainment Industry (Film/Television/Etc)
Fairground/Circus Employee
Horse Jockey/Trainer or the like
Journalist
Labourer
Market Trader
Models
Musician
Newspaper Journalists/Photographers
Nightclub Owner/Dancer/Employee
Offshore Gas/Oil Rig employee
Professional Sports person
Road Worker/Ashphalter
Scaffolder
Scrap/General (Dealers/Merchants)
Unemployed
Licensed Trade/Licensee/Publican/Employee

Profession, Occupation or trade		Type of Business
Part-time Profession, Occupation or trade		Part-time Type of Business

Daytime Tel No (inc std code)

Evening Tel No

Have you held insurance before? Insurer Policy No

No Claims Bonus % yrs Driving Basis

DRIVER DETAILS

DRIVER NAME	DATE OF BIRTH (dd/mm/yyyy)	SEX	OCCUPATION (FULL & PART TIME)	LICENCE HELD	UK TEST PASSED (dd/mm/yyyy)


Have you or any driver ever been declined or refused insurance or had any additional terms imposed?		If yes please give full details
How many years have you driven motorhomes?

ACCIDENTS/CLAIMS/LOSSES

Have you or any driver had any accident(s), claim(s) or loss within the last 3 years irrespective of blame? If yes please give full details below

DRIVER	DATE (dd/mm/yyyy)	DETAILS	OWN COSTS	3RD PTY COSTS

CONVICTIONS

Have you or any driver ever been convicted or charged (but not yet tried) or received notice of intended prosecution of any criminal offence?
Have you or any driver ever been convicted or charged (but not yet tried) or received notice of intended prosecution of any motoring offence? If yes please give full details below

DRIVER	DATE (dd/mm/yyyy)	OFFENCE	FINE	BAN

MEDICAL CONDITIONS/DISABILITIES

Do you or any of the drivers suffer from any mental, medical, or physical infirmity that is notifiable to the DVLA. If yes please give full details

DRIVER	DATE OF ONSET (dd/mm/yyyy)	DISABILITY/ILLNESS	MEDICATION

VEHICLE DETAILS

MAKE/MODEL	BODY	CC	YEAR	REG NO		VALUE
					£


Is the vehicle left hand drive?		Do you have the sole use of another vehicle for main daily use?
Current mileage reading.		Annual mileage limit required.
Is the vehicle an American or Japanese import?		Has the vehicle been modified or altered in any way other than its original conversion into a motorhome or motor caravan.
Are you a member of an owners club? If yes supply full details.		Are you or your spouse the registered owner of the vehicle? If no supply full details.
Address at which the vehicle is kept.		Details of any security devices on the vehicle
Please confirm where the vehicle is garaged or parked.
Have you owned the vehicle for more than 12 months?

USE

Social Domestic and Pleasure Purposes (EXCLUDING commuting)

COVER

Cover	Time cover required	Date cover required

ADDITIONAL INFORMATION

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WARNING
If you have any doubt about a particular fact being material to this insurance you should disclose it. Failure to disclose all material information may result in the insurance not being operative. It is an offence under the Road Traffic Acts to make any false statement or to withhold material information for the purpose of obtaining a Certificate of Motor Insurance. Insurers pass information to the Claims and Underwriting Exchange Register run by Insurance Database Services Ltd (IDS Ltd) and the Motor Insurance Anti-Fraud and Theft register, run by the Association of British Insurers (ABI). The aim is to help insurers check information provided and also to prevent fraudulent claims.

Underwriters reserve the right to decline any proposal.