The Insurance Centre - Norwich

 
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Insurance Services of The Insurance Centre NorwichInsurance Services
To receive a quotation for Motor Insurance, please fill in the form below or call our hotline on 01603 400755. If you require temporary insurance cover, pleae click here.
We regret that we can only quote for UK residents.
PLEASE NOTE: Fields marked '*' are required.
ABOUT YOU
Name*
Address*
Post Code*
Daytime Telephone*
Email Address*
CAR
Make
(e.g. Ford, BMW)*
Model
(e.g. Focus LX , 318i)*
Engine CC* Year Manufactured*
Value* Is the vehicle garaged overnight?* Yes No
DRIVERS
*
Insured Only Insured and Spouse Insured and Named
MAIN DRIVER
Sex* Male Female Age*
Type of current licence held* Full Provisional Period current licence held*
Occupation* Employed Self-Employed
Do you or does any person have defective vision or hearing, diabetes or any physical or mental infirmity or fits of any kind?* Yes No If YES, please give details
Have there been any accidents, damage, fire of theft losses during the past 3 years?* Yes No If YES, please give details. NOTE: Any loss should be disclosed whether or not a claim was submitted to the Insurer concerned.
Have you or any person who will drive been convicted during the past 5 years of any offence in connection with any motor vehicle?* Yes No If YES, please give details (e.g. conviction(s) endorsement offence code, date, fine, and period of disqualification's(if any))
Resident in UK for 3 Years or more?* Yes No
YOUNGEST ADDITIONAL DRIVER
Sex Male Female Age
Type of current licence held Full Provisional Period current licence held
Occupation Employed Self-Employed
Do you or does any person have defective vision or hearing, diabetes or any physical or mental infirmity or fits of any kind? Yes No If YES, please give details
Have there been any accidents, damage, fire of theft losses during the past 3 years? Yes No If YES, please give details. NOTE: Any loss should be disclosed whether or not a claim was submitted to the Insurer concerned.
Have you or any person who will drive been convicted during the past 5 years of any offence in connection with any motor vehicle? Yes No If YES, please give details (e.g. conviction(s) endorsement offence code, date, fine, and period of disqualification's(if any))
Resident in UK for 3 Years or more? Yes No
COVER
Type* Comprehensive Third Party Fire & Theft Third Party Only
Voluntary Excess £50 £100 Other
USE
* Social/Domestic Class 1
No. of  years No Claims Discount*

Protect No Claims?

Yes No
Additional Cars? Yes No

If YES, how many


 

 
The Insurance Centre | 8 - 10 Cromer Road | Norwich | Norfolk | NR6 6ND
Tel: 01603 400755
| Email: enquiries@insurance-centre.com
Authorised and regulated by the Financial Services Authority - 306113