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Van Insurance Quotation
To help us provide you with out best possible quotation, please complete as much of the following quotation form as you can.
More information about this quotation
Policy Holder Details
Email Address (Required)
Trading Name (If Applicable)
Forename: (Required)
Surname: (Required)
Address: (Required)
PostCode: (Required)
Home Phone number:
Work Phone Number: (Required)
Fax Number:
Vehicle Details
Vehicle Registration Number
Vehicle Manufacturer:

eg. Volkswagen

eg. Transporter
Engine Size

eg. 2448cc or 2.5
Vehicle Type
Gross Vehicle Weight / Carrying Capacity

eg. 1500kg
Year Of Registration:
Reg Letter:
Q Plated
Date Of Registration
Date Purchased
Vehicle Value
Purchase Price
Fuel Type:
Transmission Type:
Colour Of Vehicle
Paint Finish
Number Of Doors
Left Hand Drive:
Alarm Fitted:
(If yes - Make & Model)
Imobiliser Fitted:
(If yes - Make & Model)
Tracker Fitted:
Vehicle Modifications:
Body kits, etc
Vehicle Kept:
Vehicle Owner
Vehicle Keeper
Parked Postcode
Annual Personal Mileage
Annual Business Mileage
Total Mileage
Current Odometer Reading
Odometer Reading Date
Insurance Cover Details
Quotation Required
Vehicle Useage
Excess Required

eg £250
Number of Years No Claims
Is protected bonus required
Previous Insurance Company
Insurance Expiry Date
Proposer Type
Driver 1 Details
Date Of Birth
Marital Status:
Driving Licence Type:
Years Licence Held For :
Resident In UK Since
This Driver Is
Medical Conditions
Driving Qualifications
Ever Been Refused Insurance
Ever Had Terms Imposed
Home Owner:
(If yes how long Years)
Employment Status
Accidents / Claims Or Any Losses In The Last 5 Years
Fault / Non Fault
Motor Convictions In Last 5 Tears
Ever Had Suspensions
Any Criminal Convictions
WestPennine Insurance Services Group is the trading name of WestPennine Insurance Consultants Limited. Registered Office 84 Church Street, Littleborough. OL15 8AU. Registered in England number 939318
Telephone 01706 378990 Fax 01706 371417
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