Vehicle addition or replacement form

Forms / Vehicle addition or ...

[* Indicates required fields]

Policy number:*

Surname or Company Name of the Insured:*

Initials:

Email Address:

Replace an existing vehicle with this vehicle:*

No
Yes

Reason for cancellation:

Sold
Stolen
Accident

As From which date?*

Registration Number:

Details of the Vehicle Being Added:

Inception Date:*

Cover:*

Comprehensive
Limited
Third Party only

Class of use:*

Private
Business

Make:

Model:

Year:

Registration No:

Details of New Vehicle:

Manual
Automatic
Leather seats
Metallic Paint
Air Conditioning
Sun Roof
Power Stearing

Engine Number:

Chassis Number:

Is there sound equipment installed?

No
Yes

Type:

Radio/Tape
CD Shuttle

Make and Model:

Factory Installed:

No
Yes

Value of sound equipment:

Value of Vehicle (sound equipment included):

Is the Vehicle Equipped with any of the Following?

Alarm:
Factory installed immobiliser after June 95:
Vesa approved immobiliser:
Vesa approved gear-lever lock:
Lock-up Garage overnight:
Tracking device:

In whose name is the vehicle registered?

Who will be driving the vehicle?

Is there a nominated driver

No
Yes

If yes, please give name of nominated driver:

Nominated driver's ID:

Where will the vehicle be used?

I hereby certify that the above information is correct.*

(Mark box)