Motor Trade Insurance Application Form

Applicant full name

First NameMiddle NameLast Name

Business / trading name

Business type

Main business address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Phone number

Please enter a valid phone number.Format: (000) 000-0000.

Email address

example@example.com

Preferred contact method

Type of Motor Trade Business

Years in Business

Estimated Annual Turnover / Trade Volume

Business Operates Full-Time or Part-Time

Brief Description of Day-to-Day Motor Trade Activities

Premises Address (if different from business address)

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Storage Facilities

How are vehicles stored overnight?

Estimated number of vehicles on site at peak times

Are customer vehicles kept on the premises?

Desired Cover Start Date

Date

Policy Type / Cover Level

Road Risk Cover Needed?

Additional Covers Required

Endorsements / Special Requirements

Special Cover Requirements or Endorsements Requested

Types of vehicles handled

Maximum vehicle value handled

Approximate number of named drivers

Driver age range

High-risk driver history or other relevant driver concerns

Have you had any insurance claims or losses in the past 5 years?

If yes, provide details of claims or losses (dates, type, amount, and outcome).

Have any insurance applications, policies, or renewals been refused, cancelled, or declined?

If yes, provide full details of any refusals, cancellations, or declines.

Are there any convictions, disqualifications, or other underwriting issues to declare?

Describe your premises security measures and any other material facts or additional risk details.

Motor Trade Insurance Application Form

Applicant and Business Details

Motor Trade Operations

Premises and Vehicle Storage

Cover Requirements

Vehicles and Drivers

Claims and Risk History