Freightsure - specialist haulage insurance


Name :
Date of birth :
Email Address :
Tel :
Fax :
Address :
Occupation :
Operationg base postcode :
HGV license type :
Date HGV test passed :
Nature of goods carried :
Hazardous goods :	Yes No
Alarm/immobiliser fitted :	Yes No
Vehicle Details
Make/model and body type :
GVW :
Value :
Year :
Years NCD :
Any modifications :
Cover :
Trailer Details
Make/model :
Type :
Drawbar	Semi-trailer
Value :
Year :
Any modifications :
Where is the vehicle/trailers parked when not in use
Will vehicles be used on the continent :	Yes No
If yes, give details of countries visited :
Tipping risks :	Yes No
Lifting risks :	Yes No
Drivers :	IOD AnyDriver+25 Insured +1 Named
Age of youngest driver :
Additional driver details	Name: D-o-b: Occupation: License Type: Date Passed:
Claims :	Date: Amount own damage: £ Amount third party damage: £
Convictions :	Name: Date: Conviction Code: Points:
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