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Amendments to vehicle insurance
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Vehicle user information
Division or department
Name of the establishment/team vehicle is assigned to
Contact name at the establishment/team
Email address
Cost centre and GL account to be used for insurance premium charges
Vehicle information as stated on log book (V5C)
Vehicle registration
Type of vehicle
Make
Model
Value (excluding VAT)
Estimated annual mileage
Engine capacity (cc)
Fuel type
diesel
petrol
electric
hybrid
unknown
Weight
Number of seats including driver
Tailboard attached?
Yes
No
Required cover period
Is the vehicle on temporary hire?
Yes
No
On cover date/purchase date
On cover date/purchase date: Day
On cover date/purchase date: Month
On cover date/purchase date: Year
Off cover date/purchase date
Off cover date/purchase date: Day
Off cover date/purchase date: Month
Off cover date/purchase date: Year
Additional information
