Quotation Request

Acorn Direct Motor Trade

Business Details
Business Activities
Risk details
Proposer
Driver 2
Driver 3
Driver 4
Driver 5
Vehicles
Extensions
Calculated Fields

Business Details

Is your business a New or Existing Business Venture
What is your Registered Company name ?
Main Contact Name
Name
Title
First Name
Surname
Partners Name
First Partner's Postcode

Please enter your Postcode and select "Get Address" or enter your details manually

Second Partners name
Second Partner's Postcode

Please enter your Postcode and select "Get Address" or enter your details manually

Third Partners name
Third Partner's Postcode

Please enter your Postcode and select "Get Address" or enter your details manually

Trading Name (If no trading name, please leave blank)
What date was the company established?
Is your company VAT registered ?
Please enter your Trading Address Postcode

Please enter your Postcode and select "Get Address" or enter your details manually

Please enter your residential Postcode

Please enter your Postcode and select "Get Address" or enter your details manually

What type of Premises do you operate from ?
Please advise what Security measures are in place at this property ?
Do you require cover for vehicles at the premise?
What is the total maximum value of vehicles (£) at the premises at any one time?
Please provide your Mobile Number
Please provide your Email address

Business Activities

How long have you been trading ?
What is your primary motor trade activity?
Please indicate your primary motor trade activity.
Please Describe Other :
What does your company Specialise In
Please describe Other:
Are you a full time Motor Trader ?
What is your main occupation ?
Occupation
Add row
Do you require cover for this occupation ?

Risk details

When would you like your Cover to start ?
at
Please enter the maximum value of any one vehicle you own (£)

Please note: This is for each individual vehicle you own

Do you require Comprehensive cover for customer vehicles?

Comprehensive Cover only

Customer vehicle indemnity limit (£)
How many years No Claims Bonus do you have ?
What type of policy was this earned from ?
Do you require protected No Claims Bonus?
Protection is available at 1 year or more, subject to no fault claims in the last 12 month'

Do you require cover for:

Vehicles in Excess of 3.5 Ton ?
Sports/ High performance vehicles ?
Do you own, or likely to own, any Private Car vehicle over 3000cc ?
Do you work on Private Cars with an engine over 3000cc ?
Do you handle Imported Vehicles that do not have a UK equivalent specification ?
Vehicles manufactured in USA or Canada ?
How many vehicles of this type handled per year ?
Do you handle vehicles with 8 seats or more ?
Motor Homes, Caravanetts, Quad Bikes, Three Wheeled Vehicles or Kit Cars ?
Please give details.
Do you have any trade plates ?
Enter trade plate number(s) below

Proposer

Relationship
Please enter your name
Please enter your Date of birth
Have you been resident in the UK since birth?
Residency in the UK?
How long have you held your Licence ?
Use for Proposer ?

Please Note: All employees requiring usage that includes pleasure will be referred to our underwriters for approval.

Have you had any driving convictions in the last three years ?
Convictions
Conviction CodeDate of Conviction
Add row
Have you been Disqualified from Driving ?
Please give details of disqualification/revocation
Have you had any claims in the last 3 years ?
Claims
Date of ClaimStatus
Add row
Do you have any Medical Conditions (Notifiable to DVLA) ?
Please give details of medical conditions
Do you have any Criminal Convictions (including pending) ?
Please give details of criminal convictions
Have you ever had insurance, refused, cancelled, declined or had any special terms imposed?
Please give details

Driver 2

Relationship to Proposer
Named Driver 2 Occupation
How many hours a week does the driver work for the proposer ?
Title
Forename
Surname
Date of birth
Licence Type
How long has the named driver held their Licence ?
Use for this driver ?

Please Note: All employees requiring usage that includes pleasure will be referred to our underwriters for approval.

Has the named driver had any driving convictions in the last three years ?
Convictions
Conviction Code Date of Conviction
Add row
Has the Named Driver ever been Disqualified from Driving ?
Length of Ban ?
Please give details of disqualification/revocation.
Has the named driver had any claims in the last 3 years ?
Claims
Date of Claim Status
Add row
Has the driver got any Medical conditions (Notifiable to DVLA)
Please give details of Medical Conditions
Has the Driver got any Criminal Convictions (including pending) ?
Please give details of convictions
Have the Driver ever had insurance, refused, cancelled, declined or had any special terms imposed?
Please give details

Driver 3

Relationship to proposer
Named Driver 3 Occupation
How many hours a week does the driver work for the proposer ?
Title
Forename
Surname
Date of birth
Licence Type
How long has the named driver held their Licence ?
Use for this driver ?

Please Note: All employees requiring usage that includes pleasure will be referred to our underwriters for approval.

Has the driver had any driving convictions in the last three years ?
Convictions
Conviction Code Date of Conviction
Add row
Has the driver had any claims in the last 3 years ?
Claims
Date of ClaimStatus
Add row
Does the Driver have any Medical conditions (Notifiable to DVLA)
Please give details of medical conditions.
Does the Driver have any Criminal Convictions (including pending) ?
Please give details of criminal convictions.
Has the driver ever been Disqualified from Driving ?
Length of Ban ?
Please give details of disqualification/revocation.
Has the driver ever had insurance, refused, cancelled, declined or had any special terms imposed?
Please give details

Driver 4

Relationship to proposer
Named Driver 4 Occupation ?
How many hours a week does the driver work for the proposer ?
Title
Forename
Surname
Date of birth
Licence Type
How long has the named driver held their Licence ?
Use for this driver ?

Please Note: All employees requiring usage that includes pleasure will be referred to our underwriters for approval.

Has the driver had any diving convictions in the last three years ?
Convictions
Conviction CodeDate of Conviction
Add row
Has the driver had any claims in the last 3 Years ?
Claims
Date of ClaimStatus
Add row
Any Medical conditions (Notifiable to DVLA)
Please give deatils of medical conditions.
Any criminal conviction (including pending) ?
Please give details of criminal convictions
Have you been Disqualified from Driving ?
Length of Ban ?
Please give details of disqualification/revocation.
Have you ever had insurance, refused, cancelled, declined or had any special terms imposed?
Please give details

Driver 5

Relationship to proposer
Named Driver 5 Occupation ?
How many hours a week does the driver work for the proposer ?
Title
Forename
Surname
Date of birth
Licence Type
How long has the named driver held their Licence ?
Use for this driver ?

Please Note: All employees requiring usage that includes pleasure will be referred to our underwriters for approval.

Has the driver had any driving convictions in the last three years ?
Convictions
Conviction CodeDate of Conviction
Add row
Has the driver had any claims in the last 3 Years ?
Claims
Date of ClaimStatus
Add row
Any Medical conditions (Notifiable to DVLA)
Please give details of medical conditions.
Any criminal convictions (including pending) ?
Please give details of criminal convictions
Have you been Disqualified from Driving ?
Length of Ban ?
Please give details of disqualification/revocation.
Have you ever had insurance, refused, cancelled, declined or had any special terms imposed?
Please give details

Vehicles

Please enter vehicle details below

Owned Vehicles
Registration MakeModel Vehicle typeGVW (in KG)
Add row

Please take care to complete this section accurately as this is the information that will appear on the policy schedule and be transmitted to the MID.

Email Address for MiD Portal access registration

Please ensure that you detail the email address correctly. Failure to do so will result in the client login not being sent. This login can be direct to client or yourselves.

Extensions – Our policies do not cover the below as standard, however we may be able to help. Please check the relevant box for the cover you require.

Do you require cover for Transporters ?

Please tick yes to this box should you operate a vehicle transporter

Do you require Windscreen cover ?

Please Note: This extension applies to Comprehensive cover only

Do you require cover for Motorcycles ?
(Standard policy excludes)
Do you require cover for trailers ?
(Standard cover is Third Party)
Do you require Demonstration cover ?

Demonstration cover will allow prospective buyers test drive a vehicle prior to purchasing this from you.

Do you require Protected No Claims Bonus ?
Do you require cover for Vehicle in Transit ?

If you carry vehicle on a trailer or transporter, this cover will ensure the vehicles that are being transported are covered whilst in transit.

Please specify Registration of the Vehicle being used

Calculated Fields

Post Code Area
MTPostcodeArea
post code area 2
MTpostcodearea2
Rate Area
MTRate_Area
RATE AREA
MTRate_AreaB
Driver 1 Age
Base Rate for Driver 1
MTBaserate
Driver 2 Age
Driver 2 base rate
MT_DR2BaseRate
2nd driver on use code
MTDR2useload
Driver 2 Relationship code
MTRelat2
2nd Driver % initial LOAD
DR2rateload
Driver 3 Age
Driver 3 base rate
3rd driver on use code
MTDR3useload
Driver 3 Relationship code
MTRelat3
3rd Driver % initial LOAD
Driver 4 Age
Driver 4 base rate
4th driver use code
MTDR4useload
Driver 4 Relationship code
4th driver % initial LOAD
Driver 5 Age
Driver 5 base rate
5th driver use code
MTDR5useload
Driver 5 Relationship code
MTRelat5
5th driver % initial LOAD
Driver 1 conviction points in last 3 years
MTDR1_ConvictionPoints3Years
Driver 2 conviction points last 3 years
MTDR2_ConvictionPoints3Years
Driver 3 conviction points last 3 years
MTDR3_ConvictionPoints3Years
Driver 4 conviction points last 3 years
MTDR4_ConvictionPoints3Years
Driver 5 conviction points last 3 years
MTDR5_ConvictionPoints3Years
Driver 1 Conviction Load
MTDR1_convictionload
Driver 1 Claims Load
Driver 1 Premium
MTDR1_Premium
£
Driver 2 Conviction Load
MTDR2_convictionload
Driver 2 Claims Load
Driver 2 Premium
MTDR2_Premium
£
Driver 3 Conviction Load
MTDR3_convictionload
Driver 3 Claims Load
Driver 3 Premium
MTDR3_Premium
£
Driver 4 Conviction Load
MTDR4_convictionload
Driver 4 Claims Load
Driver 4 Premium
MTDR4_Premium
£
Driver 5 Conviction Load
MTDR5_convictionload
Driver 5 Claims Load
Driver 5 Premium
MTDR5_Premium
£