BoCar Insurance Quotes, Boston Insurance Services, UK

Buildings & Contents

Motor - Van - Bike

Travel & Events

Commercial

The form below will enable you to receive an insurance quote. Just complete all details as requested. The more information you can give, the more accurate the quote.

IMPORTANT: We can only quote up to 30 days in advance of cover date.

This form CAN NOT be used if:-
You have a Criminal conviction that is not spent under the Rehabilitation of Offenders Act 1974.
Or have had an insurance policy cancelled or refused.

If either of the above statements apply to you we may still be able to offer a quote but you will need to call 01205 357357 for assistance.

Tell us about you.....

(Fields marked * are mandatory)
About You:
Title:		Address 1:
Forename:		Address 2:
Surname:		Town:
Tel/Mobile: *		County:
Email Address: *		Post Code:

Tell us about your car.....

About Your Car:
Make (eg Ford):		Value:
Model (eg Focus):		Year of Make:
Type (eg GL:		Date Purchased:
Engine Size (CC):		Registration Plate:
Number of doors:		Body Type:
Gearbox Type:		Fuel:
Number of Seats:		R/H Drive or L/H Drive:
Vehicle kept overnight:		Security fitted to vehicle:
Who owns the vehicle:		Modifications to vehicle:

Use and cover.....

Use & Cover:
Cover Required:		Voluntary Excess:
Class of Use:		Protect Your NCB:
Cars In Household:		NCB Held:
Drivers To Be Insured:		Annual Mileage:

Proposers Details.....

Proposers Details:
Title:		Date Test Passed (dd/mm/yyyy):
Forename:		Residency In UK (Years):
Surname:		Occupation:
Date Of Birth (dd/mm/yyyy):		Employers Business:
Marital Status:		Employment:
Licence Held:		Driver Status:
Home Owner:		Do You Own Other Cars?:
Use Of Other Cars?:

Additional Drivers.....(SKIP TO 'Claims & Convictions' IF PROPOSER ONLY DRIVER)

Second Driver Details:
Title:		Date Test Passed (dd/mm/yyyy):
Forename:		Residency In UK (Years):
Surname:		Occupation:
Date Of Birth (dd/mm/yyyy):		Employers Business:
Marital Status:		Employment:
Licence Held:		Driver Status:
Relationship To Proposer:		Do They Own Other Cars?:
Use Of Other Cars?:

Third Driver Details.....

Third Driver Details:
Title:		Date Test Passed (dd/mm/yyyy):
Forename:		Residency In UK (Years):
Surname:		Occupation:
Date Of Birth (dd/mm/yyyy):		Employers Business:
Marital Status:		Employment:
Licence Held:		Driver Status:
Relationship To Proposer:		Do They Own Other Cars?:
Use Of Other Cars?:

Fourth Driver Details.....

Fourth Driver Details:
Title:		Date Test Passed (dd/mm/yyyy):
Forename:		Residency In UK (Years):
Surname:		Occupation:
Date Of Birth (dd/mm/yyyy):		Employers Business:
Marital Status:		Employment:
Licence Held:		Driver Status:
Relationship To Proposer:		Do They Own Other Cars?:
Use Of Other Cars?:

Claims & Convictions.....(SKIP TO 'Driver Declaration' IF NOT APPLICABLE TO ANY DRIVER)

Claims & Convictions:
Driver:
Date (dd/mm/yyyy):
Conviction Code:
Fine or Cost of Accident (£):
Points:
Disqualification Period (months):
No Claims Discount Reduced?
Fault Claim?
Type:

Driver Declaration.....

Driver Declaration:
Has the Proposer obtained a "Pass Plus" certificate?:		Has any driver been refused insurance?:
Has any driver been convicted of a motoring offence?:		Has any driver been involved in an accident or made a claim?:
Has any driver any disabilities?:
If yes, please describe any disabilities below and confirm DVLA have been informed and length of any restricted licence issued:

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