Central-Insurance.co.uk

Call us now on 024 7622 8791 - 9am-5:30pm Mon-Fri, 9am-1pm Sat

Existing Customers

Quotation for Adding a Driver

Use this form to submit details of an additional or possible additional driver. This form is for quotation purposes only. We will not make any changes to your policy until you confirm your requirements.


Your Details - we need these to find you on our system
Customer reference	(if known)
Full Name
First Line of Address
Post Code
Email Address
Daytime Phone No
New Driver Details
Title
Full Name
Date of Birth
Gender	Male Female
Marital Status
Relationship to Proposer
Type of Licence
Date Licence Held from	(e.g. 01/01/90)
Main Occupation	(e.g. Factory Worker)
Employers Business	(e.g. Manufacturing)
Self Employed	Yes No
Any Part Time Occupation
Employers Business
Self Employed	Yes No
Use for this Driver
Frequency of Use
Number of Vehicles this Driver has Access to
Number of Vehicles this driver owns
Has this driver been involved in any accidents, claims or losses in any vehicle owned or driven by them?	Yes No - if Yes please provide full details with dates, costs and fault/non-fault
Has this driver any motoring convictions, convictions involving fraud or dishonesty or ever been declared bankrupt?	Yes No - if Yes please provide full details with conviction code(s), dates and details of any disqualification
Does this driver from any medical or physical condition?	Yes No - if Yes please provide full detail of condition with dates
Has this driver ever been refused insurance or had special terms imposed?	Yes No - if Yes please provide full details with dates
Date Cover Required	(e.g. 01/01/04)
Additional Comments
No cover is in force and you should not assume cover is in force until we confirm cover both verbally and in writing. If you need cover urgently, you should call us on 024 7622 8791. We will not make any changes to your policy until you confirm your requirements.
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