Motor Proposal Form

Would you like to add any additional drivers? Yes/No
You can add up to 2 other people on your insurance.
If YES to any of the above, give details below

Driver Two details

If you don't tell your insurer about previous incidents or claims, your car insurance may not pay out if you make a claim.
Has any insurance company in connection with this class of insurance
VEHICLE DETAILS
VEHICLE USAGE
COVER POLICY DETAILS
Optional extras
GENERAL HEALTH QUESTIONS
REASONABLE PRECAUTIONS AND FRAUDULENT ACTS
You must take all reasonable precautions for the maintenance and safety of the Insured Property and prevention of loss. We will not be liable for any loss, damage, injury or liability arising from a deliberate or fraudulent act committed by you or on your behalf
DECLARATION.
I warrant
  • that to the best of my knowledge and belief that all statements and particulars given in this proposal whether in my own hand or not are true and complete in every respect and I have not withheld any material facts.
  • that I agree to give immediate written notice to the Company of any alteration of the risk herein submitted and subject to such notice the payment of each renewal premium shall be considered to have reaffirmed the answers to the questions on the proposal
  • that this Proposal form shall be the basis of the contract between the Company and myself.
  • that my insurance shall not be effective until I have paid the premium.
  • that I understand that non-disclosure or misrepresentation of a material fact may entitle the Company to void the Insurance