Private Ambulance

Registration Number

Vehicle Make

Vehicle Model

Vehicle Year of Make

Vehicle Engine Size

Vehicle Fuel Type

Vehicle Transmission

How many seats does the vehicle have?

--Please select-- 1 2 3 4 5 6 7 8 9 10 11 12+

What is the estimated vehicle value?

--Please select-- Under £1000 £1000 - £3000 £3000 - £5000 £5000 - £10000 £10000-£25000 £25000-£50000 £50000-£75000 £75000 - £100000 Over £100000

What is the Gross Vehicle Weight?

--Please select-- Under 3.5 Tonnes 3.5 - 7.5 Tonnes 7.5 Tonnes 8 - 32 Tonnes 32 - 44 Tonnes Over 44 Tonnes Don't Know

Is the vehicle Right or Left Hand Drive?

--Please select-- Right Hand Drive Left Hand Drive

What do you use the vehicle for?

--Please select-- Social Domestic & Pleasure Carriage of Own Goods Courier/Delivery Plant & Equipment Mobile Shop/Catering Breakdown/Recovery Motor Trade Club or Association Agricultural Haulage Livestock Transport/Carrier Scrap or Waste Disposal Horsebox Other

How many vehicles do you want to insure under this policy?

--Please select-- 1 2 3 4 5+

Do you use the vehicle for Courier or Delivery?

Do you use the vehicle for business in connection with the Motor Trade?

Where is the vehicle normally kept overnight?

--Please select-- Public Road Driveway Garage Locked Compound Residential Parking Other

How long have you owned the vehicle?

--Please select-- Not bought yet 0 - 6 Months 6 - 12 Months 12 - 24 Months More than 24 Months

Are you a full time in business?

--Please select-- Yes No Not in Business

How long have you been working/trading in this business?

--Please select-- Less Than 1 Year 1 year 2 years 3 years 4 years 5+ years

What is the approximate annual mileage?

--Please select-- 0 - 3,000 Miles 3,000 - 5,000 Miles 5,000 - 8,000 Miles 8,000 - 10,000 Miles 10,000 - 15,000 Miles 15,000 - 20,000 Miles More than 20,000 Miles