Title:

-please select- Mr Mrs Miss Ms Dr other If other:

First Name(s):

Last Name:

eMail Address:

Marital Status:

Married Single Live together common law

Your date of birth:

Were you born in the UK?

yes no

How long have you lived in the UK?

House Number and Street

Post Code:

House Owner?

yes no

Garage Post Code (if different from above):

Your telephone number:

Your occupation:

Type of licence:

Full Motorcycle Restricted Motorcycle Provisional Motorcycle Full Car International Timber garage

    Number of years held:

Have you passed the CBT?

yes no

Who owns the Bike?

Vehicle Manufacturer (e.g. Suzuki, Yamaha):

Model (e.g. ZX-9, YZF etc):

Cylinder Capacity:

Value of Bike:

Year of Manufacture:

Date bike purchased?

mm/yyyy

Is the motorcycle kept in a locked

 brick, stone or concrete built garage?

Other Parking Arrangements if not garaged:

yes no

  Please Select Anchored in Wooden Shed Wooden Shed Metal Motorcycle Garage Car Park Carport Locked Building Locked Compound Parked on Drive Private Property Public Road

Additional garage security (bolts, alarm etc):

Do you use sold secure/ride recommended chains or locks?

yes no

Do you use a sold secure or ride recommended ground anchor?

yes no

Provide details of your security:
(Datatool Veto, Oxford Monster etc.)

Estimated annual mileage:

Is the motorcycle fitted with alarm/immobiliser?

yes no (full details will be required)

Previous riding experience:

PLEASE TYPE DETAILS OF PREVIOUS OWNED MOTORCYCLES - INCLUDING MAKE/MODEL AND ENGINE SIZE AND HOW LONG OWNED.

Who is going to ride the vehicle?

Only me Me and my spouse Me and a named rider
Details of additional rider:

His / Her Title:

-please select- Mr Mrs Miss Ms Dr other If other:

First Name:

Surname:

Relationship to you:

Their date of birth:

Their occupation:

How long have they held a full UK licence?

Years

Have you or any other driver had any accidents or claims in the last five years?

yes no
Brief details, whether at fault, costs and dates:

Have you or any other driver been convicted of any motoring offence?

yes no

Please state dates, conviction code, no of points and details of any disqualification or ban:

Type of cover required:

Please select Comprehensive Third Party Fire and Theft Third Party Only

Will you use the bike for:

Please select 1. Social Domestic and Pleasure 2. 1 + Commuting 3. 1 + 2 and Business

If Commuting or Business, do you have secure, private workplace parking?
yes no.
Lockit2me membership no.:

Number of years 'No Claims Bonus' Held:

Nil 1 2 3 4 5 6 7 7+ years
Do you wish to protect your bonus? yes no

Date cover required:

(subject to prior approval)

Best quote so far:

£ from: with: £ excess

How would you like to receive your quote?

e-mail  telephone
fax - at