Cofton Insurance Services

Commercial Insurance


Taxi Form

Please complete the taxi form below to receive a quotation.

Please try to fully complete this form as any omissions may affect the quotation given. Upon completion please press the "Submit" button to proceed remembering to include your preferred method of contact, email, fax or telephone.

We aim to provide a fast response to your enquiry and will endeavour to acknowledge receipt of your enquiry the same day.

Before completing the form please read the Terms of Business. If you have any queries please contact us.

Proposer’s Details

Title

Forename

Surname

 

 

Date of Birth

Marital Status

Address

Post Code

Suffix

Taxi Base Postcode

Home Telephone No.

Mobile Telephone No.

Email Address

 

Home Owner?

UK Resident?

How Long?

Years

Type of Licence

Period Licence Held

 

Years

 

Full Time Occupation

 Part Time Occupation

 Medical Disabilities

 

How long have you been driving Taxi's?

 

Years

Are you employed or self-employed?

 

Vehicle Details

Make

Model

Version (i.e. LX,TD)

Year

Fuel

Body

Transmission

No. of Doors

No. of Seats

Engine Size (cc)

Value

RHD

Registered Owner?

Is the vehicle modified?

If yes please give details

 

How long have you owned the vehicle for?

 

Where is the vehicle kept at night?

 

Do you own any other vehicles?

 

 

 

Claims (Please list details of any claims/losses/accidents or thefts in the last 3 years)

If there are no claims please tick here

Date

Incident Type

Costs

Fault

Convictions (Please list details of any convictions in the last 5 years)

If there are no convictions please tick here

Conviction Date

Offence Code

Fine

Points

Disqualified

Cover Details (Please note that you can select multiple covers for quotation purposes)

Cover

Drivers

Estimated Annual Mileage

Use

Is the vehicle licenced?

Name of Licencing Authority

No. of Years No Claims Bonus

Type of No Claims Bonus

Renewal Date

 

Please use the box below for any additional information

Best Quotation to date

Preferred Method of Contact

Can you please advise where you obtained our website details?

 


Back to Top (Clicking this will clear the form contents).

Cofton Insurance Services Limited is Authorised and Regulated by the Financial Services Authority (FSA) Registration Number 304327.
These details can be confirmed by telephoning the FSA on 0845 606 1234 or visiting their website at www.fsa.gov.uk/register