| Personal
Details |
| 1. |
Title |
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| 2. |
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| 3. |
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| 4. |
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| 5. |
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| 6. |
Gender |
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| 7. |
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| 8. |
Occupation |
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| 9. |
Address |
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| 10. |
Type of licence |
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| 11. |
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| 12. |
Period licence held |
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| 13. |
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| 14. |
Telephone number |
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| 15. |
When do you want cover to start? |
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| 16. |
Have you made any claims in the past 3
years? |
Yes
No |
| 17. |
Have you had any convictions in the past 5
years? |
Yes
No |
| |
| In case additional drivers are
there ( repeat ques no. 1 to 17 for
additional driver as well } |
| 18. |
What month is your home insurance due? |
|
| 19. |
Do you have children under the age of
16? |
Yes
No |
| 20. |
Are you a named driver on another policy
with Direct Line? |
Yes
No |
| 21. |
Do you or anyone living at your address
insure another car with? |
Yes
No |
| |
| Please tell us about your
car |
| 22. |
Vehicle Registration |
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| 23. |
Estimated annual mileage? |
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| 24. |
Estimated vehicle value? |
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| 25. |
Where is your car normally kept? |
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| 26. |
Car Manufacturer |
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| 27. |
Vehicle Model |
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| 28. |
Type of fuel? |
Diesel
Petrol |
| 29. |
Is your car |
Automatic
Manual |
| 30. |
Year of Manufacture |
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| 31. |
Primary Vehicle Use |
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