Quote Form - Competition Vehicle

Proposer Details:

Name:

Address:

Postcode:

Telephone Number:

E-Mail Address:

Date of Birth:

Occupation:

Business Type:

Vehicle Details:

Make and Model:

Registration Number:

Year of Manufacture:

Engine cc:

Value:

Specification (Grp N, Basic Clubman, Grp A or Clubman):
Select Autotest Basic Clubman Clubman Group A Group N Hillclimb/Sprint Road Rally Road Legal Circuit Racing WRC Other:

Who is the registered keeper of the vehicle:

Garaged? Give Postcode if yes:

Turbo?:

Non-Event Mileage:
Select Up to 1000 miles pa Up to 2000 miles pa Up to 5000 miles pa Up to 8000 miles pa

Does your vehicle have an MSA Logbook?
Yes No

Additional Driver Details:

Number of Additional Drivers (up to 4):
0 1 2 3 4

Convictions:

If YES give details of Date & Fine:

Previous Claims:

If YES give details of Date, Fault or Non Fault & Costs:

Cover Required:

Fully Comprehensive/Third Party Fire and Theft/Third Party Only?:

Is rally cover required? (provides TPO cover on road sections of rallies up to and including Nat A leve)l:
Yes No

Road or Stage Rallies?:
n/a Road Rallies Stage Rallies

Date Cover Required:


Target Premium:

Your Licence:

Licence Type:


Date Passed Test:

Competition Licence held:
Yes No

Trailer Cover Required (Details and Value):

Other Details:

Now please click the Submit Request button below and your form will be sent to David Auden & Associates.

We will be in touch once your quote has been calculated.