Tel: 01623 641 386     
Courier Insurance Quote
 
Midlands Insurance Services Logo


Main Menu



Courier Insurance Quotes

For UK Customers Only

Please insert your details here and one of our courier insurance advisers will contact you with a quotation shortly.

Courier insurance is designed for individuals or companies wishing to insure their vehicle for use on the road in connection with their business. Please note that we can only provide quotations for renewal or start dates within the next 30 days.

If you have any problems completing this form, please phone us on 01623 641 386 for assistance.

Proposer's/Company Details

Proposer's First Name:
Proposer's Surname:
In whose name is the policy to be issued?
Limited Company Name:
(if policy is to be issued in a limited company name)
Business / Trade use of the vehicle:
(please amend if different to 'Courier')
Business Address:  Help?
Business Postcode:  Help?
Daytime Telephone No.  Help?
E-mail Address:
*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.
Cover Details
Date Cover Required / Renewal Date: (dd/mm/yyyy)  Help?
Current Annual Premium / Best Quotation:
This may help us to get you a better quote
Name of Current / Previous Insurer:
e.g. Aviva, AXA, Allianz, ERS, QBE, RSA, Zurich, etc.
Date Business Established
Date business established: (dd/mm/yyyy)
Agency Drivers
Are agency drivers employed?Yes     No
Business of Employer / Main Contract
Business of Employer / Main Contract:

Courier Vehicle Details

Type/Category of Vehicle:  Help?
Vehicle Make (i.e. Ford, VW, etc.):  Help?
Vehicle Model (i.e. Transit, Transporter, etc.):  Help?
Vehicle Type (i.e. tdi, 190, 400, etc.):  Help?
Gross Vehicle Weight (kg):  Help?
Vehicle Engine Size (c.c.):  Help?
Registration Number (if available):  Help?
Year of Manufacture: (yyyy)  Help?
Date of Purchase of Vehicle: (dd/mm/yyyy)
Value of the Vehicle (£'s):  Help?
Additional Details
Who is the registered owner of the vehicle?  Help?
Who is the registered keeper of the vehicle?  Help?
Number of seats in the vehicle:
Fuel type:
Postcode where vehicle is kept overnight:
(if different from your business address)
Where is vehicle parked overnight?
Annual mileage driven in the vehicle:
Has the vehicle been imported?Yes     No  Help?
If yes, please provide details
of where the vehicle was imported from:
Details of immobiliser / alarm:  Help?
Is a camera fitted?
Reversing aids:
Type of goods carried:  Help?
Drop location:
Drop type:
Is the vehicle modified?Yes     No  Help?
If yes, please provide details of the modifications:
Is the vehicle sign written?Yes     No
Is the vehicle Left Hand Drive?Yes     No  Help?
Details of use of the vehicle:

Cover & Driving Details

Cover
Type of cover required:  Help?
Total excess amount:
(lower premiums for a higher excess)
 Help?
Number of Years No Claims Bonus:  Help?
Type of policy No Claims Bonus earned under:
Is Protected No Claims Bonus required?
(only available if you have at least 4 years no claims bonus)
Yes     No  Help?
Further Details
Do you, or any of the drivers
have any non-motoring convictions?
Yes     No  Help?
If yes, please provide details:
(i.e. name of driver,
date(s) of conviction(s),
reason for conviction(s)
amount of any fine(s) (if applicable),
length of custodial sentence (if applicable), etc.)
Have you, or any other driver ever
had any insurance refused/cancelled or
special terms imposed within the past 5 years?
Yes     No
If yes, please provide details:
(i.e. name of driver,
date insurance refused/cancelled/special terms,
reason for insurance refused/cancelled/special terms, etc.)
Have you, or any other driver
ever been declared bankrupt, insolvent, or
ever had any IVA's, CCJ's or Sheriff Decrees?
Yes     No
If yes, please provide details:
(i.e. name of driver,
date of bankruptcy/insolvency/IVA/CCJ,
date bankruptcy/insolvency/IVA/CCJ discharged or settled,
amount of bankruptcy/insolvency/IVA/CCJ,
reason for bankruptcy/insolvency/IVA/CCJ, etc.)
Driving Details
Who will drive the vehicle?

Proposer's / Main Drivers Details

Proposer's / Main Driver's Details
Status:
First name:
Surname:
Occupation:
(please amend if different to 'Courier Driver')
Is this full-time or part-time work?
Employment status:
Date of birth: (dd/mm/yyyy)
Driving status:
Marital status:
Number of years resident in the UK?
Type of licence:  Help?
Number of years licence held: years  Help?
Driving licence number (if available):
(this may help you obtain a more competitive premium)
Does the proposer also own a car?Yes     No
If yes, please state number of years
no claims discount on the car policy:
Please advise if there have been any accidents
or claims in the last five years (regardless of fault)?
Yes     No  Help?
If yes, please provide details:
Please advise if there have been
any motoring convictions or offences?
Yes     No  Help?
If yes, please provide details:
Please advise if there are any
medical conditions or disabilities?
Yes     No  Help?
If yes, please provide details:

Additional Drivers (max. 3 additional drivers)
Do you wish to add another driver?Yes     No

Details Of Driver 2
Status:
First Name:
Surname:
Their Primary Occupation:
(please amend if different to 'Courier Driver')
Their Employer's Business:
(please amend if different to 'Courier Service')
Employment status:
Date of birth: (dd/mm/yyyy)
Driving status:
Marital status:
How long have they lived in the UK:
Type of licence:
How long have they held their licence? years
Driving licence number (if available):
(this may help you obtain a more competitive premium)
Relationship to Proposer:
Has this driver had any accidents or claims
in the last five years? (regardless of fault)
Yes     No  Help?
If yes, please provide details:
Has this driver ever been
convicted of any motor offences?
Yes     No  Help?
If yes, please provide details:
Does this driver have any
medical conditions or disabilities?
Yes     No  Help?
If yes, please provide details:

Additional Drivers
Do you wish to add another driver?Yes     No

Details Of Driver 3
Status:
First Name:
Surname:
Their Primary Occupation:
(please amend if different to 'Courier Driver')
Their Employer's Business:
(please amend if different to 'Courier Service')
Employment status:
Date of birth: (dd/mm/yyyy)
Driving status:
Marital status:
How long have they lived in the UK:
Type of licence:
How long have they held their licence? years
Driving licence number (if available):
(this may help you obtain a more competitive premium)
Relationship to Proposer:
Has this driver had any accidents or claims
in the last five years? (regardless of fault)
Yes     No  Help?
If yes, please provide details:
Has this driver ever been
convicted of any motor offence?
Yes     No  Help?
If yes, please provide details:
Does this driver have any
medical conditions or disabilities?
Yes     No  Help?
If yes, please provide details:

Additional Drivers
Do you wish to add another driver?Yes     No

Details Of Driver 4
Status:
First Name:
Surname:
Their Primary Occupation:
(please amend if different to 'Courier Driver')
Their Employer's Business:
(please amend if different to 'Courier Service')
Employment status:
Date of birth: (dd/mm/yyyy)
Driving status:
Marital status:
How long have they lived in the UK:
Type of licence:
How long have they held their licence? years
Driving licence number (if available):
(this may help you obtain a more competitive premium)
Relationship to Proposer:
Has this driver had any accidents or claims
in the last five years? (regardless of fault)
Yes     No  Help?
If yes, please provide details:
Has this driver ever been
convicted of any motor offence?
Yes     No  Help?
If yes, please provide details:
Does this driver have any
medical conditions or disabilities?
Yes     No  Help?
If yes, please provide details:

Additional Optional Covers

Goods In Transit Cover
Is Goods In Transit cover required?Yes     No
Goods In Transit sum insured (e.g. £10,000):
Public Liability Insurance
Is Public Liability cover required?Yes     No
Public Liability limit of indemnity:
Legal Expenses Cover
Is Legal Expenses cover required?
(£50,000 standard limit)
Yes     No
Additional Information / Material Facts
Details of any additional information or material
facts that may affect the acceptance of this insurance:
Under the legal principle of Utmost Good Faith, you are required to disclose all material facts which could affect acceptance of this insurance quotation. Failure to disclose a material fact could invalidate any future claims. By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.

Request Courier Insurance Quote

Disclosure
Please ensure that all the information you have provided is correct and that you have answered all the questions accurately then press the Request Courier Insurance Quote button to send your quotation details to us.


Estimated Quote Time: 1 to 72 hours