Kerridge Insurance Services Limited. Nationwide Motor Car Insurance and other Insurance Services.

Personal and commercial insurance services from your local independent insurance broker.

Kerridge Insurance Services

Why Choose Kerridge?
The Kerridge Team

Services

Financial Advice
Motor Insurance
House Insurance
Commercial Insurance
Travel insurance

Quotation Request

Motor
House
Travel

Enquiry Form
Postal Address

Your Details

Your Title
Your Full Name
Address
Postcode
Country
Telephone
E-Mail Address
Date of Birth
Your Age
Occupation
Employers Line of Business
License Type
Held Since
Years No Claims Bonus?
Is It Protected?	Yes , No
Number Of Cars In Family?
Do You Have Any Disabilities?
Marital Status
Have you passed the Pass Plus qualification?	Yes , No

If you have NIL no claims bonus, have you just finished driving a company car? If so, how many years were you driving one? (A letter from an employer confirming this will be needed.

Number of years driving company car?
Have you, or any of the drivers been convicted of a criminal offence or been delared bankrupt?
Are you a homeowner?

Car Details

Make Of Car (eg Ford Escort)
Model Type (eg GL, Ghia)
Engine Size (cc)
Registration Number
Year of Manufacture
Body Type
Gear Change
Any Modifications?	Yes , No
If YES, Give Details
Is the car a Japanese grey import?	Yes , No
If yes, please provide details
Estimated Current Value £s
Estimated Annual Mileage
Do You Own The Vehicle?	Yes , No
If NO, Who Is Owner?
Where Is The Car Kept Overnight?

Additional Driver Details

Driver 1 Full Name
Age
Occupation
License Type
Held Since
Relationship to you

Driver 2 Full Name
Age
Occupation
License Type
Held Since
Relationship to you

Driver 3 Full Name
Age
Occupation
License Type
Held Since
Relationship to you

Claims

Driver	Date	Accident Details	NCB Effect	Costs Incurred

Convictions

Driver	Date	Conviction Code	Banned?		Points?	Fine £
			Yes	No
			Yes	No
			Yes	No

Cover & Use Required

Cover Required:
Use:
What date is the Cover required from
Please give details of any other quotations you may have had
	or