Vehicle Registration Number (if Known):
---AbarthAlfa RomeoAlpinaArielAscariAston MartinAudiBentleyBMWBristolBugattiCadillacCaterhamChevroletChryslerCitroenCorvetteDaciaDaihatsuDavid BrownDFSKDodgeDSElementalFerrariFiatFiskerFordGinettaGreat WallHondaHummerHyundaiInfinitiInvictaIsuzuIvecoJaguarJeepKiaKodeKTMLamborghiniLand RoverLexusLotusLykanMarcosMaseratiMaybachMazdaMcLarenMercedesMGMINIMitsubishiMorganNissanNoblePeroduaPeugeotPorscheProtonQorosRadicalRenaultRolls-RoyceSaabSEATSkodaSmartSRTSsangYongSubaruSuzukiTeslaToyotaTridentVauxhallVolkswagenVolvoWestfieldZenos
Year of Manufacture:
Less than £1000£1001 to £2500£2501 to £5000£5001 to £10,000£10,001 to £15,000£15,001 to £20,000£20,001 to £25,000£25,001 to £30,000£30,001 to £35,000£35,001 to £40,000£40,001 to £45,000£45,001 to £50,000£50,001 to £75,000£75,001 to £100,000£100,001 to £125,000Greater than £125,001
Estimated Annual Mileage:
1000 Miles2000 Miles3000 Miles4000 Miles5000 Miles6000 Miles7000 Miles8000 Miles9000 Miles10000 Miles11000 Miles12000 Miles13000 Miles14000 Miles15000 Miles16000 Miles17000 Miles18000 Miles19000 Miles20000 Miles21000 Miles22000 Miles23000 Miles24000 Miles25000 Miles26000 Miles27000 Miles28000 Miles29000 Miles30000 Miles31000 Miles32000 Miles33000 Miles34000 Miles35000 Miles36000 Miles37000 Miles38000 Miles39000 Miles40000 Miles41000 Miles42000 Miles43000 Miles44000 Miles45000 Miles46000 Miles47000 Miles48000 Miles49000 Miles50000 Miles
Where will the vehicle be parked overnight:
GaragedParked On DriveCarportKept on Public RoadKept on Private RoadKept on Private PropertyCar ParkOther
Postcode of where the vehicle will be kept:
Date of Birth:
Home Phone Number:
Mobile Phone Number:
Have you been resident in the UK longer than 12 months?
EmployedSelf EmployedUnemployedRetiredHousehold DutiesIn Full or Part Time EducationIndependent MeansContractorFinancially AssistedNot employed due to disabilityVoluntary Work
Driving Licence Type:
Full UK Driving LicenceProvisional (UK) Driving LicenceFull EU Driving LicenceFull European (Non-EU) Driving LicenceFull International Driving LicenceOther
How long have you held a licence for?:
20 years or more19 years18 years17 years16 years15 years14 years13 years12 years11 years10 years9 years8 years7 years6 years5 years4 years3 years2 years1 yearsLess than 1 year
How many years No Claims Discount have you earned in the UK on a private car in your name? (your no claims discount proof must be no more than 2 years old):
10 years or more9 years8 years7 years6 years5 years4 years3 years2 years1 yearsLess than 1 year
Have you had any motoring claims, accidents or losses, regardless of blame, in the last 5 years, or has anyone made a motoring claim against you?
None123456 or more
If Yes, please specify claim type, date and details of claim:
How many motoring convictions or fixed penalty notices have you received in the last 5 years?
None123456 or more
If yes, please specify conviction code, date of offence, points, length of ban (if applicable).
Would you like to add any additional drivers?:
No Extra Drivers1 Extra Driver2 Extra Drivers3 Extra Drivers4 or More Extra Drivers
What is the vehicle used for?
Social, Domestic and PleasureSocial, Domestic, Pleasure and CommutingPersonal Business UseOther
When would you like the cover to start (Must be within the next 45 days):
In order to service and administer your policy we will share your details with Great British Finance Limited and its group of companies and brokers. By completing this quote you are giving us permission to contact you via email regarding your quote for an annual policy. We will not contact you for any other reason unless you agree that we may do so.
Simply FInancial Advice Ltd and the GBF group of companies would like to use your personal details to:
- confirm, update and improve their customer records;
- analyse and develop their relationships with you;
- help in processing any applications you may make;
- identify and market products and services that may be of interest to you either directly or via GBF Insurance plc;
- carry out statistical analyses.
The Simply Financial Advice Ltd and GBF may also disclose your information to other carefully selected partners so they may let you know about other appropriate products or services which they feel may be of interest to you. The GBF group will not sell your information to third parties.
If you would prefer us not to contact you about other products, services and offers via any of the communication methods listed below, please select No in each case.
Telephone: Yes No
SMS/Text: Yes No
Post: Yes No
Email: Yes No
Please confirm you are happy with the selections above*
Simply Financial Advice Ltd
Derby West Business Centre
p: 0800 044 5733
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