Motorhome Insurance Quotation

Please complete this form with your details and email to us - we will calculate your quote and call you or email you with your quote, normally the same day
(if we receive your quote form between 8.30am - 5.30pm Monday to Friday).

When you want to go ahead there will not be any more forms to complete!

Contact Details
 
Name:
Home Telephone:
Daytime or work Telephone:
Mobile Telephone:
E-mail (required):  

Vehicle & Cover Details (Please note we cannot insure self-built conversions) 
 
Type of Cover:
Manufacturer of motorhome:
Model of motorhome:
Base vehicle make Gearbox:
Base vehicle model (if applicable)
Year of Registration:
Estimated value: £ 
Vehicle registration number:
Length (metres) Width (metres)   Engine Capacity:cc
Alarm/Immobiliser details:  
Annual mileage?
How many Months have you owned the vehicle Do you have use of another vehicle?:
Number of days foreign use per annum
Drivers required:
Type of Use:   
Are you a club member?
   

Driver Details
 
Proposer - Main Driver Second Driver
Title: Title:
Forename: Forename:
Surname: Surname:
Address: Relationship:
     
Town:    
County:    
Post Code:      
Post Code Where Kept (if Different)    
  Licence: Licence:
Licence date  Licence date 
Claim-free driving?
(We will allow a good-driver discount)
UK residency UK residency
Marital status Homeowner? Marital status
 Birthdate: Birthdate:
Occupation: Occupation:
Employer's Business: Employer's Business:  
   
Third Driver Fourth Driver
Title: Title:
Forename: Forename:
Surname: Surname:
Relationship:   Relationship:
  Licence:   Licence:
Licence date  Licence date 
UK residency UK residency
Marital status Marital status
 Birthdate: Birthdate:
Occupation: Occupation:
Employer's Business: Employer's Business:  
 

 

  

Accidents, claims or losses in the past 5 years 
 
Date / Circumstances / Cost of Claim / Was No Claims Discount affected? 
Driver Main SecondThirdFourth
Driver Main SecondThirdFourth

Convictions in the past 5 years (but include any drink/drugs offences or other serious convictions up to 11 years ago)
 
Date / Offence Code / Points / Fine / Suspension period / Alcohol level (if appl)
Driver Main SecondThirdFourth
Driver Main SecondThirdFourth
Driver Main SecondThirdFourth
Driver Main SecondThirdFourth

Disabilities or infirmities (these should have been notified to DVLA, Swansea)
 
Please Specify, with details of duration & treatment & any restrictions on driving licence
Driver Main SecondThirdFourth
 
Is your vehicle kept:  at the storage postcode given above?
Date cover required: This should be within the next 30 days
Target Premium: Please state your current premium  
This will help us quote the best premium possible.
Need to add or explain something? (e.g modifications, security etc) Tell us here:

All quotations assume that the risk is acceptable to underwriters at normal terms, taking account of the information you have supplied. If there are any material facts that may affect underwriters assessment of the risk, you should disclose it above. If in doubt about any fact, we recommend you do disclose it, or consult us.