Sports Car Insurance Quote Form

352 Avebury Boulevard, Central Milton Keynes, MK9 2JH Tel: 0344 8921966 Fax: 0344 8921967 www.competition-car-insurance.co.uk

Sports Car Insurance Quote Form Name Date of Birth Home Telephone Occupation No. Mobile Telephone E-mail No. address Start/ Renewal Full UK Licence Yes / No Year Issued Date Home Address (inc postcode): Storage Address (if different):

Details of any claims in last 3 years including dates Details of any convictions in the last 5 years including and costs( regardless of Fault dates, points fines and disqualifications

Who is the vehicle Purchase date (approx) owner? Make and Model No. Seats Engine Size Current Value BHP Year of Registration Number No. Manufacture Doors Cat 1 Security Yes / No Cat 2 Yes / No Active Tracker Yes / No Security Modifications

NCD available to use NCD on another NCD Protection (5 Yes / No car yrs+ only) Storage Garage / Drive / Road / Other If other- Details

Car Club/ Forum your are a Paid Membership Yes / No member of High Performance Driving Course Completed

Mileage Restriction Up to 2000 / up to 4000 / up to 6000 / up to 8000

Use Required Social Domestic & Pleasure / Commuting /

Voluntary Excess (In addition £0 / £50 / £100 / £150 / £250 to any compulsory) Uninsured Loss Recovery Yes / No (legal assistance £25.00) Driver Required Insured Only / Insured & Spouse(common law) / Insured plus up to 3 other drivers Please list your experience driving high performance vehicles:

Additional Driver 1 Date of Birth Occupation Full UK/ EU Licence Yes / Year Issued No Details of any claims in last 3 years including dates Details of any convictions in the last 5 years including and costs( regardless of Fault dates, points fines and disqualifications

Additional Driver 2 Date of Birth Occupation Full UK/ EU Licence Yes / Year Issued No Details of any claims in last 3 years including dates Details of any convictions in the last 5 years including and costs( regardless of Fault dates, points fines and disqualifications

Additional Driver 3 Date of Birth

Occupation Full UK/ EU Licence Yes / Year Issued No Details of any claims in last 3 years including dates Details of any convictions in the last 5 years including and costs( regardless of Fault dates, points fines and disqualifications

NOTE: STANDARD EXCESS IS £250. THE FOLLOWING ADDITIONAL EXCESSES WILL APPLY DEPENDENT ON THE VEHICLE VALUE: £25,001- £50,000 = £ 250 Compulsory Excess (Total £500) £50,001- £75,000 = £750 Compulsory Excess (Total £1000) £75,001- £100,000 = £1750 Compulsory Excess (Total £2000) £100,001- £150,000 = £2500 Compulsory Excess (Total £2500) I you would like a quote or more information regarding any other products provided by Competition Car Insurance Please Tick the Boxes Below Track Day/On Event Accidental Damage Commercial/ Business Insurance cover Personal Accident Motor Trade