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Car
Car
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You
You
Your Cover
Cover
Cover
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Quote
Quote
About you
Personal details
Personal details
Title
Mr
Mrs
Miss
More...
Ms
Mx
Dr
First name
Surname
Date of birth
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
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15
16
17
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19
20
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22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
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1984
1983
1982
1981
1980
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1978
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1974
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1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
How long have you lived in the UK?
We need to know how long you have continuously lived in the UK. This needs to be the date from which you've lived here as a permanent resident up to now and not include any gaps in residency of 6 months or more.
?
Since birth or Since
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
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Your relationship status
Single
Married
Married - Common Law
More...
Partnered - Civil
Divorced
Widowed
Confirm
Your driving licence
Your driving licence
What type of licence do you have?
Full UK Car Licence
Provisional (UK) Car Licence
Full EU Licence
Full International Licence
Full European (Non-EU)
Medical Restricted (Full) 3 Years Or More - Car
Other
How long have you held this licence (years)?
Please select
less than a year
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15+
How long have you held this licence (months)?
0 months
1 month
2 months
3 months
4 months
5 months
6 months
7 months
8 months
9 months
10 months
11 months
Have you had any driving related convictions, endorsements, penalties, disqualifications or bans in the past 5 years?
This will include any pending motoring convictions that you may have.
?
Yes
No
Do you have any medical conditions notifiable to the DVLA?
We will need to know more information about any medical conditions or disabilities that may affect your ability to drive, or notifiable driving licence conditions.
?
Yes
No
Confirm
Other Information
Other Information
Have you had any accidents, thefts or losses within the last 5 years regardless of fault/non fault or whether this resulted in a claim?
Please fill in as much detail as possible, if you are unsure your previous insurers should have more information.
?
Yes
No
Have you ever had insurance declined?
Yes
No
Have you ever had any special terms imposed on a previous insurance policy?
Yes
No
Have you ever had insurance cancelled?
Yes
No
Do you have any unspent non-motoring criminal convictions?
A 'spent conviction' is a conviction which, under the terms of the Rehabilitation of Offenders Act 1974, can be effectively ignored after a specified amount of time.
?
Yes
No
Confirm
Contact details
Contact details
Mobile number
Telephone number
Email address
Confirm
Your household
Your household
Do you have any children under 16 years old?
Yes
No
How many cars are at your home?
Confirm
About your employment
About your employment
What is your employment status?
Employed
In Full Or Part Time Education
Self Employed
Household Duties
Retired
Unemployed
Not Employed Due To Disability
Voluntary Work
Independent Means
What is your main occupation?
This is what you do for the majority of the time. For example if you are in Full-time education and you have a Part-Time job, you should select "Full-time education".
?
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What industry is this occupation in?
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Do you have a part-time/additional job?
Yes
No
What is your part-time/Additional Job Status?
Employed
In Full Or Part Time Education
Self Employed
Household Duties
Retired
Unemployed
Not Employed Due To Disability
Voluntary Work
Independent Means
What is your part-time/Additional Job Role?
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What is your part-time/Additional Job Employer's Business?
{{ secondaryIndustryResult.text }}
Confirm
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