Rescue Policy

Personal Details

For cover to commence, please complete this page in full.
Please note: Cover is in principle & there is no cover in force on the vehicle until we have contacted you either by e-mail or telephone to confirm this. If cover is required immediately, please contact us on 02476 595812, and we will arrange this for you.

Personal Details

Title *

Forename(s) *

Surname *

Email address *

Home phone no. *

Find your address

Enter your postcode and click 'Find my address' *

House name/number *

Street address *

Suburb

Town *

County *

Postcode *

Vehicle/Trailer Details
(if choosing the trailer only policy, please enter the trailer details only below)

Make *

Model *

Engine size *

Registration number *

Is the vehicle kept at a different address to the one given above? *

YesNo

Year of manufacture *

(year) e.g. 1976

Gross Vehicle Weight *

Length *

Colour *

Product Details

Product Name *

Start date *

I/we declare that the answers given above (on which the Underwriters will rely in deciding whether to accept the risk) are true to the best of my knowledge and belief, and that the vehicle described is in a roadworthy condition and that no information has been withheld by me/us that might influence the underwriters acceptance and assessment of this insurance, and to accept a policy subject to the terms and conditions therein.

This is an indication of the premium which is subject to acceptance by the underwriters. In some cases the premium may be different to that quoted here. We will inform you if the premium changes and will not proceed to arrange cover without your specific acceptance instructions.

Please note: No cover in force until we have contacted you either by email or telephone to confirm.

Please click the button below to continue to our secured credit card payment service.

If you have not received any communication / confirmation of cover from us within 1 working day of submitting this request, please contact us on 02476 595812, or email us at enquiries@anthonydevans.co.uk.