Crammond Insurance: Insurance Consultants Life & Pensions
   
 

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Motor Quotation

To enable us to provide a quotation we will require the following information:

You are reminded that in law you have a Duty of Disclosure of facts that could affect the Insurers decision to insure (material facts).  Any changes in circumstances, such as claims, convictions, change of occupation, etc which is not disclosed to your Insurer could invalidate a claim you may have.

Personal Information
Name Title First Name Initials Surname
 

Date of Birth

Address
PostCode
Fax
E-Mail
 

 

Car Details
Make Model Engine Size Value
 
Year Type No. Of Seats Modified
Yes No
 
Reg No Date of Purchase Proposed Annual Mileage  
 
 
Security Alarm Immobiliser Tracker
 
Other Owner Overnight Parking No. Of Cars in
Household
 
Cover
 
Class of Use
 
Driving
Current Insurance Insurer Renewal Date Proposed premium
No Claims (Bonus Years) No Claims Bonus Protection
Yes No
 

If you have specified any other than 'Any Driver', please enter the driver details below (i.e. for 'Insured Only', enter your details in Driver 1. For 'Insured & Spouse' enter details in Driver 1 & Driver 2. For 'Named Driver' enter details of each named driver.)

Named Driver Details - Proposers Details
Name Date of Birth Sex Marital Status
M F
Occupation Licence Type How Long Held (Years)
Own/Use Other Banned within last 10 Years
Yes No Yes No
 
Accidents or Claims (Last 5 Years)
Date Type Amount
£
£
£
£
£
 
Convictions (Last 5 Years)
Date Type Points Fine
£
£
£
£
£
 

 

Named Driver Details - Driver 1 Details
Name Date of Birth Sex Marital Status
M F
Occupation Licence Type How Long Held (Years)
Own/Use Other Banned within last 10 Years
Yes No Yes No
 
Accidents or Claims (Last 5 Years)
Date Type Amount
£
£
£
£
£
 
Convictions (Last 5 Years)
Date Type Points Fine
£
£
£
£
£
 

 

Named Driver Details - Driver 2 Details
Name Date of Birth Sex Marital Status
M F
Occupation Licence Type How Long Held (Years)
Own/Use Other Banned within last 10 Years
Yes No Yes No
 
Accidents or Claims (Last 5 Years)
Date Type Amount
£
£
£
£
£
 
Convictions (Last 5 Years)
Date Type Points Fine
£
£
£
£
£
 

 

Named Driver Details - Driver 3 Details
Name Date of Birth Sex Marital Status
M F
Occupation Licence Type How Long Held (Years)
Own/Use Other Banned within last 10 Years
Yes No Yes No
 
Accidents or Claims (Last 5 Years)
Date Type Amount
£
£
£
£
£
 
Convictions (Last 5 Years)
Date Type Points Fine
£
£
£
£
£
 

 

Named Driver Details - Driver 4 Details
Name Date of Birth Sex Marital Status
M F
Occupation Licence Type How Long Held (Years)
Own/Use Other Banned within last 10 Years
Yes No Yes No
 
Accidents or Claims (Last 5 Years)
Date Type Amount
£
£
£
£
£
 
Convictions (Last 5 Years)
Date Type Points Fine
£
£
£
£
£
Any other relevant information or additional covers required:
Data Protection:
So that we may fully understand your circumstances and requirements, Cramond Insurance Consultants Ltd will collect all the information you provide and will hold this as Data controllers under the Data Protection Act 1998. 

Our regulator the FSA requires us to keep records of our business transactions for at least 3 years.  Some records are required to be held for longer.  However, we will not keep records longer than is necessary.  To protect your privacy, you, or your appointed agent, have a right to inspect computer (and certain manual) records relating to yourself and your transactions through ourselves and where appropriate have it corrected or deleted.  All such requests for information must be referred to George Minty.  As we treat all our clients' records as private and confidential, we reserve the right to give you copies of your records, where in certain circumstances to release the original would compromise other clients' confidentiality.

You are also aware that we or any such company may contact you in the future by any means of communication considered appropriate at the time in relation to matters mentioned.  There may be occasions where our regulator the FSA, as part of their regulatory function, requests to look at your personal information or records of your transactions, as held by ourselves.  They may also need to contact you directly.  On such occasions, you agree that we may disclose such information to the FSA and that the FSA may contact you directly if they so require.  By sending the information to Cramond Insurance Consultants Ltd It is deemed that you accept the aforementioned terms.
 

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