Iffa | Taxi Insurance Quotation Form

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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:

Home owner *

Any Children Under 16 *

Contact Info

Email address

Mobile *

Driving History

Type of License *

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

Taxi Licensing Authority (City Council)

Date first taxi badge issued

Date current/renewed taxi badge issued

Operating Area (e.g., Liverpool City)

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 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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Taxi 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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