pro-indemnity.co.uk Commercial Vehicle Proposal Form  Note that this form is normally for non-fleet use, typically up to 5 vehicles. 1. Your Name:  Company Trading Title:  Type of Company: Sole TraderPartnershipLimited Company- 2. Address of your premises:  Post Code:            Telephone Number:  E-mail address:  Website address: If you need to list more vehicles, use the form available by clicking here. Please specify the total number of vehicles you wish to list : 3. Vehicle Details  Vehicle 1  Vehicle 2 Vehicle Registration: Vehicle make: Vehicle model: Body type: Carrying Capacity: Gross vehicle weight: Year of manufacture: Engine size: (cc) Value: £ Colour: Metallic Paint?:  Yes No  Yes No Current mileage reading: Annual mileage: Any modifications from standard?:  Yes No  Yes No Security fitted? (alarm, immobiliser):  Yes No  Yes No  If you replied "Yes" to modifications or security, please provide details: Cover Required: ComprehensiveThird Party, Fire & TheftThird Party, Only- ComprehensiveThird Party, Fire & TheftThird Party, Only-   Number of claim free years: Previous insurers name: Date Insurance Expires: Use required: Social Domestic & Pleasure  Yes No   Business use required  Yes No   Carriage of Own Goods  Yes No   Carriage of goods for Hire and Reward  Yes No If you have ticked that business use is required, please provide number of business miles you do annually: Please provide number of personal miles annually: 4. Authorised driving: Policyholder onlyAny DriversAny Drivers Aged 21 & overAny Drivers Aged 25 & overAny Drivers Aged 30 & overNamed Drivers- NAMED DRIVERS You may enter the details for up to five drivers here. If you need to list more drivers, there are additional forms available by clicking here. Please specify the total number of drivers you wish to list : Notes Age - of driver, in years, if under (eg) 21 do you want date of birth? Occupation - typically Motortrade or Driver, but for more casual users, please specify Relationship - of driver to you - typically Business Partner, Employee, or Family Additional details - include any claims (date of claim, description, payments to third party (if known) and own payment), any convictions, whether motor related or not, in the last 5 years (date of conviction, type of conviction, penalty points and fine details), and state if the driver has been refused insurance, or had special terms imposed (possible disabilities or medical conditions). Driver Details Details of any convictions, disabilities, accidents or claims. If none state none. Driver 1 Name Age Occupation if not full-time MT Relationship Date UK driving test passed Usage Motor TradeSocial Domestic & PleasurePrivate Business Uses- Driver 2 Name Age Occupation if not full-time MT Relationship Date UK driving test passed Usage Motor TradeSocial Domestic & PleasurePrivate Business Uses- Driver 3 Name Age Occupation if not full-time MT Relationship Date UK driving test passed Usage Motor TradeSocial Domestic & PleasurePrivate Business Uses- Driver 4 Name Age Occupation if not full-time MT Relationship Date UK driving test passed Usage Motor TradeSocial Domestic & PleasurePrivate Business Uses- Driver 5 Name Age Occupation if not full-time MT Relationship Date UK driving test passed Usage Motor TradeSocial Domestic & PleasurePrivate Business Uses- If you need to list more drivers, additional forms are available by clicking here. If you need to list more vehicles, use the form available by clicking here.  Please supply me with an estimate within 510 working days. Done Please check your details, and when you are happy that all is correct, tick 'Done' and click the Submit button above...