Delite Insurance Agency


info@deliteinsurance.co.uk

7 Livingstone Circus
Gillingham
Kent ME7 4HA

Phone: 0845 8639466
Fax: 01634 283829


Delite Insurance Agency

Taxi Quotation

All fields must be fully completed or delays and possible decline may occur

Contact Information
 
Full Name:
Company/Trading Name:
Postcode (eg: AB12 3CD):
Date of Birth:
Telephone:
Mobile:
Email Address:
Occupation:
Type of Licence:
No. of years held:
Convictions:
Make of Vehicle:
Model of Vehicle:
CC (engine size):
No. of Doors:
Licensing Authority:
Year Registered:
Current Value:
No Claims Bonus:
How Gained?:
Kept Overnight:
Driving Restriction:
Cover Required:
Usage:

ADDITIONAL DRIVER
Full Name:
Date of Birth:
Occupation:
Type of Licence:
No. of years held:
Relationship:

CLAIMS IN THE PAST 5 YEARS
Driver:
Date of Incident:
Type of Claim:
Amount Claimed:
Fault/Non Fault:
Driver:
Date of Incident:
Type of Claim:
Amount Claimed:
Fault/Non Fault:
 
Security Code:

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