Please call for a quotation on : 01277 374807   GOODS IN TRANSIT
		Please enter your details below. We will contact you within 24 hours of submitting the online quotation, on the condition it is within our normal working hours. 9-5 Monday to Friday (excluding bank holidays) / 9-12 Saturdays
		Type Of Insurance : How Did You Hear About Us :   Please Select .............................. Van Courier Car Courier Haulage Private Car Standard Van Please Select .............................. Internet Postal And Courier Magazine Recommendation Dispatches Magazine Courier Exchange Web Site Yellow Pages Yell.com CRV Solutions Other Insurer
		Date Cover Required : Client Name : Contact Number : Daytime Number : E-Mail Address : Date of Birth : Day : Month : Year :
		Postcode where vehicle is kept at night :   House Number :   How long have you had a full UK licence : Years
		Vehicle   Vehicle Make : Vehicle Model : Vehicle Type (i.e. zetec, Gti, Lx, Ghia) : Engine Size : Carrying Capacity if Van : Year of Make : Value : What Cover is required i.e. Comprehensive :
		Additional Drivers   Who will be driving, if spouse or named drivers full details will be needed. Name : Date Of Birth : Day : Month : Year : Relationship To Proposer : Occupation :   Full Time : Part Time :   How Long Held Full UK License : Please note we will contact you for full details if its not just yourself driving.
		No Claims Bonus   Years Bonus :   Does the bonus apply to this Vehicle : Yes      No If no to the above question please state which type of vehicle has the No claim bonus i.e. private car or van :
		Convictions   Driver Name Conviction Code (i.e. sp30, cd10, ts20) Conviction Date (day/mh/yr) Fine Points
		Claims   Please give brief details including total costs “approx”, was it deemed as your fault and what type of claim i.e. Accident, theft, fire.
		Quote to Beat :
		Will Goods in Transit be required, if so please specify amount of cover required.   Do you require Public liability insurance, if so please state amount required, normally £1.million will suffice.
		CFN INSURANCE SERVICES LIMITED Number 3 The Palmers - Bleak House Farm Crow Green Road - Brentwood Essex - CM15 9RP Tel No : 01277 - 374 807 Fax No : 01277 - 375 201 E - Mail : mail@cfninsurance.co.uk
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