Bike Specifics

Motorcycle for private use only?

Yes

Year of Manufacturer

Make

Model

Variant 🛈

Registration

VIN/Chassis number?

Road Registered?

Is the motorcycle in Roadworthy Condition?

Is the motorcycle new or used?

Drivers

First Name

Last Name *

Gender

Date of Birth of Oldest Insured * +

Year licence obtained

Underwriting Acceptance Criteria

Have you been declined insurance in the past 12 months

Number of criminal convictions in the past 3 years

Do you wish to Add Additional Driver to avoid additional excesses

Underwriters consideration & Comments (please provide details)

Additional Drivers First Name Surname Date of Birth Gender Year licence obtained Number of criminal convictions in the past 3 years Has there been any claims and/or licence suspensions in the past 3 years? *

Cover

Vehicle sum insured (excluding non-standard accessories and modifications)

Sum Insured Option

Agreed Value Cover Required

MotorCycle Insurance Excess Option

Does the vehicle have any non-standard accessories that will be included within the cover?

Non Standard Accessories
Please supply a description of Non Standard Accessories to be Insured and the Sum Insured

Overnight parking address

Street

City

PostCode

Current Insurer

Currently Insured

Current Premium

Declaration: I/WE HEREBY DECLARE AND WARRANT that the answers given above are in every respect true and correct, and that I/We have not withheld any information within My/Our knowledge likely to affect the decision of the Company as to My/Our eligibility for insurance. This request and declaration shall be the basis of the quote request. *

Contact Info

Phone *

Email *

Best time to Call

Additional Information