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Motor Insurance
Make
Model
Registration #
Year
Engine Size
Fuel Type
Number Of Doors
Not bought yet
Purchase Date
Vehicle Modified :
Yes
Radio
No
Radio
Legal Owner :
Yes
Radio
No
Radio
Registered Keeper :
Yes
Radio
No
Radio
Vehicle Used For
Vehicle Parked
Miles Per Annum
Driving Licence
Licence Details
# Of Years passed
Previous accidents :
Yes
Radio
No
Radio
Description Of Claim :
Fault
Radio
Non Fault
Radio
Motor Convictions :
Yes
Radio
No
Radio
Date Of Accident
Motor Charge
Cover Start Date
Renewal Price
Payment
Voluntary Excess
Cover
Insurance Declined or Cancelled :
Yes
Radio
No
Radio
Addition Driver :
Yes
Radio
No
Radio
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Additional Driver Information
First Name
Last Name
Title
Marital Status
Email
Date Of Birth
Contact Number
Address
How Long In UK
Occupation
Occupation Desc
Medical & Disabilities :
Yes
Radio
No
Radio
Driving Licence
Licence Details
# Of Years passed
Previous accidents :
Yes
Radio
No
Radio
Description Of Claim :
Fault
Radio
Non Fault
Radio
Motor Convictions :
Yes
Radio
No
Radio
