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© 2025 Prestige Insurance Brokers (UK) Limited

Fact find questionnaire

for MOTOR FLEET

FILL OUT THE FORM BELOW TO GET AN INSURANCE QUOTE

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Contact name

Email

Phone

Correspondence address

Business, Partnership Name

Trading name

Status of entity

Year established

Business description

How many Directors and/or Partners the business have in total?

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1) Full name / Date of Birth / Position within the company

2) Full name / Date of Birth / Position within the company

3) Full name / Date of Birth / Position within the company

4) Full name / Date of Birth / Position within the company

Select any of the following that apply to any Proposer, Director or Partner:

had a proposal refused or declined
had an insurance cancelled
had a renewal refused
had special terms imposed
Not applicable

Business address

Business Vehicle types:

Operator Licence type

Adjustment basis

Business postcode for Operator - Haulage (international) licence

Business postcode for Operator - Haulage (non international) licence

Business postcode for Operator - Restricted licence

Business postcode for PCV licence

Is the fleet registered in the Hazardous Industry or connected to Hazardous Location?

Airside
MOD Premises
Military Bases
Nuclear Industry Or Atomic Energy Establishments/Nuclear Installations
Petro-chemical Industry Or Petro-chem Installation
Power Stations/Electricity Generating Stations
Pyrotechnic/Ammunition Industries
Not applicable

Notification method to be used for Motor Insurance Database (MID)?

Are all drivers are supplied with driver handbooks?

Yes
No

Are the drivers supplied with details of what to do following an accident?

Yes
No

Are existing drivers have their driving licences checked periodically?

Yes
No

Are Goods Vehicle Drivers undertake SAFED training?

Yes
No

Are incidents recorded and analysed?

Yes
No

Are the new drivers have their driving licences checked?

Yes
No

How many vehicles the business have?

How many drivers the business have?

List all the Vehicles Makes / Models / Engine sizes / Registration numbers / Values/

Please list each vehicle in number order.

List all the Drivers Full Name/ DOB/ Years of driving experience / Years of NCD/ Driving Licence number / Licence Type / Licence Expiry Date

Has any of the driver?

Been declared bankrupt/insolvent
Been in breach of health and safety
Been the subject of CCJ or Scottish equivalent
Does not have a licence issued by DVLA
Had any accidents, claims or losses in the last 3 years
Had any claim repudiated/refused
Had any convictions in past 5 years
Had insurance declined or cancelled
Had insurance withdrawn or subjected to an increased rate or special conditions
Has any notifiable medical conditions of which the DVLA should be aware
Has been a director or partner in any business which has been the subject of a winding up or administrative order or administrative receivership proceeding
Has been a director or partner in any business which has been the subject of an individual voluntary arrangement with creditors, voluntary liquidation
Has non-motoring convictions and/or pending prosecutions

Please select relevant options

If any of the options above have been ticked, please state the name of the relevant driver

Do you require business use outside the UK?

Yes
No

Estimated value of business' vehicles in total

Estimated value Goods in Transit

Claim history within the last 5 years

If applicable

Any addition information?

GDPR Agreement *

I consent to having this form submitted so Prestige Insurance Brokers (UK) Ltd can respond to my inquiry.

Phone

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© 2025 Prestige Insurance Brokers (UK) Limited - Appointed Representative of TEn Insurance Services Ltd, trading as Eleven, which is authorised and regulated by the Financial Conduct Authority (FRN 314593)