Contact Name:
Company Name:
Type of Goods Carried:
Quotation Required By:
Email Address:
Company Address:
Current Insurer
Number of vehicles
Your Telephone Number:
Company Post Code:
Target Premium
 
  GVW Year of make NCB Years Does NCB originate
from car or CV?		 Please indicate basis
against each vehicle
           
1.
2.
3.
4.
5.
6.
 
Do you want us to quote for Protected
NCB as an option on those vehicles
with 5 years minimum NCB?
yes   no
Do you require Goods in Transit
cover?
yes   no
Is a higher Transit limit than £25,000 per vehicle required?
yes   no
If so what limit?
Any other material facts/information including any claim details and convictions in the last 3 years:
 
   
Bollington Wholesale is a trading name of Bollington Underwriting Limited. Registration Number 02074674. Registered Office: Adlington House, Adlington Road, Bollington, Macclesfield SK10 5HQ. Bollington Underwriting Limited is authorised and regulated by the Financial Services Authority. Part of The Bollington Group (Holdings) Limited.