Iffa | Motorbike Insurance Quotation Form

If by a friend, family or referrer please state their name

This information is solely for our marketing purpose.

or No Recommendation

Personal Info

Title *

First Name *

Surname *

Date of Birth *

House Number/Name *

First Line of Address *

Postcode *

Marital Status *

Employment/Education Status *

If Employed/Self Employed/In Education, what is your Job Title / Course Title:

If Employed / Self Employed / In Education, enter the type of business or name of university / college:

Home owner *

Any Children Under 16 *

Contact Info

Email address

Mobile *

Driving History

Type of Licence *

UK Licence Number

Period Licence held for *

Select Driving / Practical Test Pass Date: *

If you hold a UK or EU full licence, this can be found on the back of the licence in column B.
If you hold a UK provisional licence (L), please select the date the licence was issued.
For all other licence holders, please select the date you passed your driving test in that country.

Have you held a driving licence in any other country?

Yes No

Date test passed

Country licence was issued

Date CBT Passed

DVLA medical conditions or disabilities*

Any additional driving qualifications *

If one is selected, what date was qualification obtained

Were you born in the UK *

Yes No

If not born in the UK, please enter the date you moved to the UK

Use of any other vehicles *

Non motoring criminal convictions

Any motor accidents (fault or non-fault) or claims (whether claim made or not) in the last 5 years

Yes No

Motor Accidents or Claim Details

1

Type:
Date:
Damage:
Cost(£) - if known:
Fault:
Any Injuries: Yes No

2

Type:
Date:
Damage:
Cost(£) - if known:
Fault:
Any Injuries: Yes No

3

Type:
Date:
Damage:
Cost(£) - if known:
Fault:
Any Injuries: Yes No

4

Type:
Date:
Damage:
Cost(£) - if known:
Fault:
Any Injuries: Yes No

Any motor convictions, fixed penalties or disqualifications in the last 5 years *

Yes No

Motor Conviction, Fixed Penalty or Disqualification Details

1

Conviction Code:
Date of Conviction:
Points:
Fine(£) - if any:
Ban(months) - if any:

2

Conviction Code:
Date of Conviction:
Points:
Fine(£) - if any:
Ban(months) - if any:

3

Conviction Code:
Date of Conviction:
Points:
Fine(£) - if any:
Ban(months) - if any:

4

Conviction Code:
Date of Conviction:
Points:
Fine(£) - if any:
Ban(months) - if any:

Vehicle Details

Vehicle Registration *

Tick this box if you don't know the vehicle registration

Manufacturer:

Model:

Registration Year:

Alarms - Immobiliser:

Number of Seats:

Number of Doors:

Engine Size (CC):

Transmission:

Manual Automatic

Approximate value of the motorbike right now?

Does the vehicle have any modifications? *

Yes No

Please advise on what modifications have been made to the motorbike

Is the motorbike impounded with the police?

Yes No

Date of purchase:*

or Not yet purchased

Where is the vehicle kept during the day:*

Where is the vehicle kept overnight:*

Is the vehicle kept at the same address:*

If No, what is the full address of where the vehicle is kept:

Registered Keeper:

Legal Owner:

How many vehicles are in the household?:

Vehicle Usage

Have you or any of the drivers ever had insurance declined, cancelled or special terms imposed?

Yes No

Use of vehicle:*

Estimated Annual Mileage:

Type of Cover:

Any no claims discount:*

How did you earn your no claims bonus?

Was this NCD earned in the UK:

Would you like to protect your NCD:

What voluntary excess would you like:*

How do you normally pay for insurance:*

When would you like the policy to start:*

Previous Insurances Company Name

Renewal Premium Cost

Additional comments:

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By clicking submit, you agree your explicit consent for us to use the data provided in accordance with the Data Protection act 1998, this data will be used to provide the cheapest possible quote while being shared with both offline and online markets.

Motorbike Insurance Quotation Form

Personal Info

Contact Info

Driving History

Motor Accidents or Claim Details

1

2

3

4

Motor Conviction, Fixed Penalty or Disqualification Details

1

2

3

4

Vehicle Details

Vehicle Usage

Additional Drivers

Additional Driver (1) Details

Motor Accidents or Claim Details (Additional Driver 1)

1

2

3

4

Motor Conviction, Fixed Penalty or Disqualification Details for Additional Driver (1)

1

2

3

4

Additional Driver (2) Details

Motor Accidents or Claim Details (2)

1

2

3

4

Motor Conviction, Fixed Penalty or Disqualification Details for Additional Driver (2)

1

2

3

4

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