BusinessInsuranceQuotations.com Motor Trade Road Risks Insurance Proposal Form   Please note that any quotation is based upon the assumption that the necessary proof of trading (such as accounts, invoices, receipts etc.) can be provided at any time required. You may e-mail to chris@BusinessInsuranceQuotations.com or Fax to 029 2071 2919 1. Your Name: 2. Address of your premises:  Post Code:            Telephone Number:  E-mail address:  Website address: 3. Description of Business: 4. Date Established: 5. Type of Premises: DealershipIndustrial UnitLock-upHomeMobile- 6. Does your premises have it's own lockable entrance:  Yes No 7. Do you have a health and safety policy?  Yes No  Is all training recorded?  Yes No 8. Do you have an Electrical Installation Certificate?  Yes No 9. Is your Portable Electrical Equipment tested?  Yes No 10. Do you have waste oil and/or tyres removed by registered contactors?  Yes No PART A - ROAD RISK Proposers involvement in Motor Trade (Please estimate percentage of activities in each group) Buying / Selling / Wholesale: % Car breaking / Scrap: % Valeting Steam Cleaning: % Repairing and Mechanical: % Vehicle deliveries: % Breakdown / Recovery: % Other Specify: % Cover Required: Third PartyThird Party Fire and TheftComprehensive- Maximum capacity in cars: Average number of vehicles handled per year: Annual Turnover: £ Registered for VAT:  Yes No Maximum value of any own vehicle: £ Maximum value of any one customer vehicle: £ Total value of own vehicles: £ No claims discount years earned on: CarCommercial VehicleMotor Trade-  Number of years no-claims discount Do you mainly deal in -  Sports or high performance vehicles?:  Yes No  Imported modified kit cars?:  Yes No Commercial vehicles in excess of 3.5 tons GVW:  Yes No If "Yes" state capacity of vehicles: Do you require demonstration cover?:  Yes No Do you require customer loan vehicle cover:  Yes No Do you require breakdown recovery? Yes No Do you require motorcycle recovery? Yes No  If "Yes" state max: capacity (cc) cc  and state value: £ Authorised driving: Policyholder onlyAny DriversAny Drivers Aged 21 & overAny Drivers Aged 25 & overAny Drivers Aged 30 & overNamed Drivers-

Do you require Liability Insurance?  Yes No If you require Liability Insurance, please click here and complete and submit the proposal form.   CURRENT INSURERS    Name of current insurers (so that we don't approach them!)  Expiry date of current insurance  Current premium (if known) £ You may e-mail to chris@BusinessInsuranceQuotations.com or Fax to 029 2071 2919 Please supply me with an estimate within 105 working days. (We will attempt to meet the target, but please be aware that it does require our insurers to respond quickly as well!) Done