Telephone: 0208 440 6692
insurance services limited
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Buildings and contents cover offered at extremely competitive rates with all leading insurers.
 
Whether you are self-employed or employ staff, our rates have historically been the cheapest available.
The most competitive premiums available for private cars, vans and motorcycles without compromising on policy cover.
Whether cover is required for one day or one year, we offer the lowest premiums with the best cover available.
Quotation Form

Please complete all the fields below to receive an accurate quote

1. Your Details
Preferred title
First name
Surname
Date of birth (dd/mm/yy)
House No. or Name
Postcode
Contact Telephone No.
E-mail address
Marital status
Employment Status
Occupation
Driving Qualifications
Licence Held
Licenced From Date
Have you obtained Pass Plus?
 Yes No

2. Your Car Details

Make
Exact Model (e.g. Ford Escort - GL)
Engine size (cc)
Year of Manufacture
Car registration
Value of vehicle
£
Annual mileage
Where is the car parked overnight?
Does it have an electronic immobiliser?
Yes No
3. Your Cover Details

Cover Required?
Class of Use
If "Business Use",
miles per year?

Additional drivers?

If "PH plus Named Drivers",
then please fill in next section,
otherwise go to section 5.

4. Named Driver Details
Do you have any named drivers?

Driver 1 Name
Driver 2 Name
Driver 3 Name
Date of birth
Date of birth
Date of birth
Occupation
Occupation
Occupation
Licence Held
Licence Held
Licence Held
Licenced From Date
Licenced From Date
Licenced From Date
Marital status
Marital status
Marital status
Relationship to Policy Holder
Relationship to Policy Holder
Relationship to Policy Holder

5. Accidents or Claims (Driver PH is you)
Have you or your named drivers had any motor accidents or claims in the last five (5) years?

Yes No

Driver No.
Claim Date
Fault
Non-Fault
Claim Cost
Circumstances
£
£
£
£
£
£

6. Convictions (Driver PH is you)
Have you or your named drivers had any motor convictions.

Yes No

Driver No.
Conviction Date
Offence Code
Fine
Disqualification
Period
Penalty Points
£
£
£
£
£
£

7. Other Details

Years No Claims Bonus?
4+ years, Require Protected?
Yes No
Best price quoted so far?
  £
Renewal Date? (dd/mm/yy)
Are you the registered owner?
Yes No
If "No", please state the owner's name and their relationship to you
Additional Information


I confirm that I have read and accept the Terms & Conditions shown.
Yes
How did you find us?
Other
How do you prefer to be contacted?
Email Telephone
Would you like Herald Insurance to keep you informed of insurance related matters?
Yes No