Motor Cycle Quote Request
Insurer Details
Title E-mail
Forename Permanent UK resident since (year) e.g. 1976
Surname Employment status
SexMale   Female Occupation (if applicable)
DOB Employer's Business (if applicable)
Marital Status Licence type More Info
Street Address Years licence held? Yrs  Mnths
Suburb Date CBT Passed (if applicable)?
Town Years continuously insured on a motorcycle as policyholder or named rider? Yrs
County Are you a Homeowner?Yes  No
Postcode Do you have access to other vehicles?Yes  No
Home Tel No 
Mobile Tel No 
Vehicle Details
Make e.g. Suzuki Is the vehicle UK registered?Yes   No
Model e.g. GSX-R1000 Has the vehicle been modified in any way?Yes   No
Cubic Capacity cc  e.g. 250cc 
Year of manufacture  e.g. 1995 Alarm
Yes   No  
Registration number Immobiliser
Yes   No  
Approximate value £  e.g. £4500 Additional Security Markings?
Date Of Purchase Physical Security
Normal storage 
 Annual business mileage
Who is the owner of the vehicle? If Business use, please describe the usage
Maximum annual mileage 
Use & Cover
Use required    More Info Years motorcycle no claims bonus
 NCB protectionYes  No
Level of cover What is the largest cc motorcycle you have been insured on in the last 5 years?CC
Voluntary excess Who is to drive?
Policy commencement / renewal date. Will Pillion Riders be carriedYes   No
Driver History
Have you, or anyone named on the policy :-
Been involved in any accidents, claims, thefts or losses in the past 5 years?Yes   No
Had any convictions in the past 5 years, ever been disqualified or have any prosecutions pending?Yes   No
Have an uncorrected defect in vision or hearing, physical or mental infirmaty or suffered from diabetes, epilepsy or any heart complaint?Yes   No
Been declined motor insurance or had a policy cancelled or any special terms imposed?Yes   No
Completed any advanced training schemes on a motorcycle?Yes   No
Have you or any person who will drive been convicted during the past 5 years of any criminal offence or been charged with a criminal offence but not yet tried?Yes   No
Please give us any details / explanation of anything further you believe we should know. If this is related to an addident please specify which accident.
Please advise us of your most competitive quotation / renewal premium.£