<p>352 Avebury Boulevard, Central Milton Keynes, MK9 2JH Tel: 0344 8921966 Fax: 0344 8921967 www.competition-car-insurance.co.uk</p><p>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):</p><p>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</p><p>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</p><p>NCD available to use NCD on another NCD Protection (5 Yes / No car yrs+ only) Storage Garage / Drive / Road / Other If other- Details</p><p>Car Club/ Forum your are a Paid Membership Yes / No member of High Performance Driving Course Completed</p><p>Mileage Restriction Up to 2000 / up to 4000 / up to 6000 / up to 8000 </p><p>Use Required Social Domestic & Pleasure / Commuting / </p><p>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: </p><p>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</p><p>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</p><p>Additional Driver 3 Date of Birth</p><p>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</p><p>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</p>