bike quote

BIKE INSURANCE QUOTE
We aim to send you a quote via email within 24hrs.
If you would like immediate cover or would prefer to answer these questions over the phone, please call 08714 230 200.



1. General
From what date do you wish your insurance to start ?
Title
First Name
Surname
Address
Postcode
Contact Telephone Number
Email

2. Main Rider (Please give details of all persons including yourself who will or may ride the Motorcycle)


Title
First Name
Surname
Date of Birth (dd/mm/yyyy)
Gender
Marital Status
Occupation
Employer's business
Self-employed	Yes No
Part Time Occupation
Part Time Employer's Business
Current continuous period of UK residency	(years)
Number of bikes Rider owns or has access to
Type of bike licence
If EU or other please specify country issued
Date bike test passed or CBT taken (dd/mm/yyyy)

3. Do you wish to add another rider?(Please go on to question 4 if you are the only rider)

Add another rider (Additional Rider ONE)	Yes No


Title
First Name
Surname
Date of Birth (dd/mm/yyyy)
Gender
Marital Status
Occupation
Employer's business
Self-employed	Yes No
Part Time Occupation
Part Time Employer's Business
Current continuous period of UK residency	(years)
Number of bikes Rider owns or has access to
Type of bike licence
If EU or other please specify country issued
Date bike test passed or CBT taken (dd/mm/yyyy)
Relationship to proposer
Add another rider (Additional Rider TWO)	Yes No


Title
First Name
Surname
Date of Birth (dd/mm/yyyy)
Gender
Marital Status
Occupation
Employer's business
Self-employed	Yes No
Part Time Occupation
Part Time Employer's Business
Current continuous period of UK residency	(years)
Number of bikes Rider owns or has access to
Type of bike licence
If EU or other please specify country issued
Date bike test passed or CBT taken (dd/mm/yyyy)
Relationship to proposer
Add another rider (Additional Rider THREE)	Yes No


Title
First Name
Surname
Date of Birth (dd/mm/yyyy)
Gender
Marital Status
Occupation
Employer's business
Self-employed	Yes No
Part Time Occupation
Part Time Employer's Business
Current continuous period of UK residency	(years)
Number of bikes Rider owns or has access to
Type of bike licence
If EU or other please specify country issued
Date bike test passed or CBT taken (dd/mm/yyyy)
Relationship to proposer

4. Motorcycle details


Exact Make and Model (eg faired, unfaired, limited edition, etc)
Cubic Capacity cc
Year of manufacture
Date of purchase
Annual mileage
Value �
Registration Number
Is the motorcycle owned / registered in your name	Yes No
If NO please give details
Where is the motorcycle kept
Postcode of where the motorcycle is kept
Has the motorcycle been modified or tuned	Yes No
If YES please give details
Does the motorcycle have an immobiliser ?	Yes No
If YES What is the make and model of the immobiliser ?
Does the motorcycle have a permanently fitted sidecar	Yes No
No Claims Bonus available to use on this vehicle
Would you like bonus protection if eligible	Yes No
Type of cover required
Do you want to insure any other bike on this policy	Yes No


Exact Make and Model (eg faired, unfaired, limited edition, etc)
Cubic Capacity cc
Year of manufacture
Date of purchase
Annual mileage
Value �
Registration Number
Is the motorcycle owned / registered in your name	Yes No
If NO please give details
Where is the motorcycle kept
Postcode of where the motorcycle is kept
Has the motorcycle been modified or tuned	Yes No
If YES please give details
Does the motorcycle have an immobiliser ?	Yes No
If YES What is the make and model of the immobiliser ?
Does the motorcycle have a permanently fitted sidecar	Yes No
No Claims Bonus available to use on this vehicle
Would you like bonus protection if eligible	Yes No
Type of cover required
Do you want to insure any other bike on this policy	Yes No


Exact Make and Model (eg faired, unfaired, limited edition, etc)
Cubic Capacity cc
Year of manufacture
Date of purchase
Annual mileage
Value �
Registration Number
Is the motorcycle owned / registered in your name	Yes No
If NO please give details
Where is the motorcycle kept
Postcode of where the motorcycle is kept
Has the motorcycle been modified or tuned	Yes No
If YES please give details
Does the motorcycle have an immobiliser ?	Yes No
If YES What is the make and model of the immobiliser ?
Does the motorcycle have a permanently fitted sidecar	Yes No
No Claims Bonus available to use on this vehicle
Would you like bonus protection if eligible	Yes No
Type of cover required
Do you want to insure any other bike on this policy	Yes No


Exact Make and Model (eg faired, unfaired, limited edition, etc)
Cubic Capacity cc
Year of manufacture
Date of purchase
Annual mileage
Value �
Registration Number
Is the motorcycle owned / registered in your name	Yes No
If NO please give details
Where is the motorcycle kept
Postcode of where the motorcycle is kept
Has the motorcycle been modified or tuned	Yes No
If YES please give details
Does the motorcycle have an immobiliser ?	Yes No
If YES What is the make and model of the immobiliser ?
Does the motorcycle have a permanently fitted sidecar	Yes No
No Claims Bonus available to use on this vehicle
Would you like bonus protection if eligible	Yes No
Type of cover required

5. In addition to social, domestic and pleasure purposes, will the vehicle be used:

i	to and from one place of work by main rider?	Yes No
ii	for business purposes by main rider?	Yes No

If you answered YES to any of question 5, give further details in the box below.
giving as much information as possible.

6. Does any person who will drive suffer from any disabilities and/or medical conditions?

Disabilities	Yes No

If YES please state condition
Number of years diagnosed with this condition
Details of any medication taken
Is your licence restricted	Yes No
Have DVLA been advised	Yes No

7. Has any person who will drive been involved in a motor accident, theft or claim in any motor vehicle in the past 5 years?

Which named rider was involved?
What was the date of this incident?	(dd/mm/yyyy)
What type of incident was it ?
Please give a description of the incident
Cost of claim
Were ALL of these costs reclaimed from a third party?	Yes No Pending
	If No or Pending what were your own and third party costs claimed?
	Your Costs � Costs Third Party Costs � Personal Injury Costs �

Accident 2 -	Yes No

Which named rider was involved?
What was the date of this incident?	(dd/mm/yyyy)
What type of incident was it ?
Please give a description of the incident
Cost of claim
Were ALL of these costs reclaimed from a third party?	Yes No Pending
	If No or Pending what were your own and third party costs claimed?
	Your Costs � Costs Third Party Costs � Personal Injury Costs �

Accident 3 -	Yes No

Which named rider was involved?
What was the date of this incident?	(dd/mm/yyyy)
What type of incident was it ?
Please give a description of the incident
Cost of claim
Were ALL of these costs reclaimed from a third party?	Yes No Pending
	If No or Pending what were your own and third party costs claimed?
	Your Costs � Costs Third Party Costs � Personal Injury Costs �

Accident 4 -	Yes No

Which named rider was involved?
What was the date of this incident?	(dd/mm/yyyy)
What type of incident was it ?
Please give a description of the incident
Cost of claim
Were ALL of these costs reclaimed from a third party?	Yes No Pending
	If No or Pending what were your own and third party costs claimed?
	Your Costs � Costs Third Party Costs � Personal Injury Costs �

8. Has any person who will drive been convicted of any motoring offences or have any prosecution pending whilst driving any motor vehicle in the last five years?
Conviction 1 -	Yes No

Which rider was involved?
What was the date of the conviction?	(dd/mm/yyyy)
What is the conviction code?
How many points were added to the rider's licence ?
What fine amount was imposed? �
How many months ban was imposed?	months
For Drink Driving Convictions (DR codes)
Which alcohol test did the rider undergo?
What was the reading from the test?
Enter details of another conviction?	Yes No

Which rider was involved?
What was the date of the conviction?	(dd/mm/yyyy)
What is the conviction code?
How many points were added to the rider's licence ?
What fine amount was imposed? �
How many months ban was imposed?	months
For Drink Driving Convictions (DR codes)
Which alcohol test did the rider undergo?
What was the reading from the test?
Enter details of another conviction?	Yes No

Which rider was involved?
What was the date of the conviction?	(dd/mm/yyyy)
What is the conviction code?
How many points were added to the rider's licence ?
What fine amount was imposed? �
How many months ban was imposed?	months
For Drink Driving Convictions (DR codes)
Which alcohol test did the rider undergo?
What was the reading from the test?
Enter details of another conviction?	Yes No

Which rider was involved?
What was the date of the conviction?	(dd/mm/yyyy)
What is the conviction code?
How many points were added to the rider's licence ?
What fine amount was imposed? �
How many months ban was imposed?	months
For Drink Driving Convictions (DR codes)
Which alcohol test did the rider undergo?
What was the reading from the test?

Submit your request
What is the cheapest quote you've had so far? Please include premium, excess and name of insurer/broker if posible. Also tell us how you heard about us. This information will help us to provide the most competitive quotation from one of our specialist schemes.
Thank you for filling in this form


	PROFILE INSURANCE SERVICES: 52 HIGH STREET, IRCHESTER, NORTHAMPTONSHIRE NN29 7AB Telephone: 08714 230200 Fax: 08714230221 Email: info@profile-insurance.co.uk Profile is an independent intermediary acting for over 40 insurers
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