About You

Date of incident*

Choose a description of the incident *

Was the No Claims Discount affected?*

Was the No Claims Discount affected?

Yes

Did anyone involved claim for personal injury?*

Did anyone involved claim for personal injury?

Yes

Date of conviction*

Conviction code *

Type of alcohol test*

Level of reading taken*

How many points received?*

How much (£) was the fine? (please enter 0 if no fine received)*

If a ban was received, how many months was this for? (please enter 0 if no ban received)*

Your driving licence

What date was your provisional licence issued? *

How many practical driving tests have you taken?*

How many practical driving tests did you take?

Have you booked your practical driving test?*

Have you booked your practical driving test?

Yes

When is your test booked for? *

What you do

What is your current employment status? *

Type of student *

What course are you studying? *

Main occupation*

Type of business*

E.g. a shop assistant would type retail and a teacher would type education.

Do you have a second occupation?*

Do you have a second occupation?

Yes

Employment status of second occupation? *

Second occupation*

If you enter the first 3 or 4 letters of your occupation we'll show you a list to choose from.

Type of business*

For example, a shop assistant would select retailing and a teacher would select education.

Your cover

What date would you like your insurance from? *

I understand this policy is for social, domestic and pleasure use, EXCLUDING commuting*

I understand this policy doesn't cover the car being used for commercial purposes*

Claims & Convictions

Have you made any claims on any previous insurance, fault or non-fault, or had any accidents or losses when a claim was not made on previous insurance policies? *

Have you made any claims on any previous insurance, fault or non-fault, or had any accidents or losses when a claim was not made on previous insurance policies?

Yes

Have you ever had insurance refused, cancelled or had any special terms imposed? *

Have you ever had insurance refused, cancelled or had any special terms imposed?

Yes

Have you had any motoring or non-motoring convictions that are not spent under the Rehabilitation of Offenders Act 1974? *

Have you had any motoring or non-motoring convictions that are not spent under the Rehabilitation of Offenders Act 1974?

Yes

Have you got any penalty points, any convictions pending (motoring or non-motoring) and/or been disqualified from driving? *

Have you got any penalty points, any convictions pending (motoring or non-motoring) and/or been disqualified from driving?

Yes

10 min

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About You

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What you do

Your cover

Claims & Convictions

10 min

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About You

Personal information

Your driving licence

What you do

Your cover

Claims & Convictions

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