Fleet Insurance

Registration No.

Year

Make, Model & Body Type

Trailer

Carry Capacity (t)

Radius (kms)

Main Base of Operation

Dangerous Goods

Sum Insured ($)

Registration No.

Year

Make, Model & Body Type

Trailer

Carry Capacity (t)

Radius (kms)

Main Base of Operation

Dangerous Goods

Sum Insured ($)

Registration No.

Year

Make, Model & Body Type

Trailer

Carry Capacity (t)

Radius (kms)

Main Base of Operation

Dangerous Goods

Sum Insured ($)

Registration No.

Year

Make, Model & Body Type

Trailer

Carry Capacity (t)

Radius (kms)

Main Base of Operation

Dangerous Goods

Sum Insured ($)

Registration No.

Year

Make, Model & Body Type

Trailer

Carry Capacity (t)

Radius (kms)

Main Base of Operation

Dangerous Goods

Sum Insured ($)

Has anyone comprising the insured, or any intended driver, either alone or jointly with others, ever been fined/convicted of a traffic offence in the last five years?

Had a driving license endorsed, suspended or canceled in the last five years?

Had any accidents, fires or lodged a claim in connection with motor vehicles during the last five years?

If 'Yes' to any of the above questions, please state full details:

Has anyone comprising the insured, or any intended driver, either alone or jointly with others, ever: Been convicted of a criminal offence in the last ten years?

Been declared bankrupt or put into liquidation or receivership?

If 'Yes' to any of the above questions, please state full details:

Please enter your contact details below so we can contact you regarding your quotation.

Your Full Name

Daytime Phone Number

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