westcraveninsurance.com
Please complete the details below as fully as possible.
Full name:
Correspondence address:
Postcode:
Telephone:
Email address:
Risk address (if different):
Risk postcode (if different):
Risk telephone (if different):
Full description of your business and type of goods carried:
Full description of your premises e.g. shop, public house, factory, warehouse etc.:
Do you have a claims history (within 5 years)? Yes No
Date: D: M: Y:
Details of loss:
Amount:
Type of property: RHA/All risk European
Sum assured:
Countries visited:
Annual charges:
In any one package:
In each vehicle (inclusive of trailer):
Make of vehicle & registration number:
Type of body:
Load limit:
Total number of own vehicles:
Will they be left loaded overnight? Yes No
Please give details of security:
Keep vehicle registration:
Add GHV: