Motor Trade Insurance Quote | Dolmen Insurance Brokers Ltd

Code (For Office Use Only)

Details taken by

Phone or Counter Call

Date & Time Capture

Date

Hour Minutes

Customers Name

Trading Name/Limited Company Name if Applicable

Email

example@example.com

Address

Address Line 1

Address Line 2

City/TownCounty

Eircode

Is the Risk Address different than the Home address

Risk Address

Address Line 1

Address Line 2

City/TownCounty

Eircode

Are You Registered for Vat or Registered with Revenue as a Motor Trade Business

Contact Number

% Breakdown in your business activities

Rows	Breakdown out of 100%
Servicing & Repairs of Cars & Light Commercials
Sales of Cars & Light Commercials
Sales/Repairs of Agri Vehicles
Sales/Repairs of HGV Vehicles
Recovery Services
Tyre Sales, Fitting & Repairs
Valeting
Car/Light Commercial Vehicle Breaking
Windscreen Fitter
Panel Beating/Crash Repairs
Auto Electrician
Mobile % if Required
Window Tinting/Sign Writing

Full Time or Part time in the Motor Trade:

If Part Time – What’s your other source of income:

Annual Turnover

Gross Turnover from Motor Trade Activites

Date of Birth

Licence Type

How Many Years Held:

Resident in Ireland Since

Bonus Type

Number of years claims free experience:

Max Gross Vehicle Weight:

Current UID Number

Do You Own or Deal in any Modified, High Performance or Classic Vehicles: A FULL LIST OF THE CLIENTS VEHICLES ARE REQUIRED IN THE BOX BELOW

Full List of Vehicles Above

Do you Own Any Recovery Vehicles:

Recovery Truck Details

Rows	Recovery Truck 1	Recovery Truck 2	Recovery Truck 3
Make
Model
Gross Vehicle Weight
How Many can it carry
How many can it tow
Value €
REG/Year

Own or work on Motor Cycles:

Motor Cycle Details

Rows	Details
Is Business Use only required
Is Social Domestic & Pleasure Use only required
Is MT & Social Domestic Pleasure use required
Do you hold a full or provisional bike licence

Experience/Qualified

Ever Held A PSV Licence (Taxi Licence)

Cover

Additional Drivers:

List All Drivers

Has any driver ever had any Accidents / Claims / Convictions (motoring & Non-motoring):

Number of Penalty Points:

Present Insurer:

Renewal/Inception Date :

Code (For Office Use Only Kennco YDD)

KennCo - Preferred Young Driver Discount Checklist

The proposer must meet all of the following criteria:

Customer Vehicle Exception

Customer vehicles being driven for legitimate Motor Trade puroposes are not subject to the vehicle ownership restrictions above.

Broker name

Proposer name

Proposer's employer

Date

MTRR policy number or quote number

A LIST OF ALL VEHICLES OWNED BY THE INSURED:

Any additional information:

How Did You Hear About Us

In order to obtain you a quotation we need your permission to submit your details provided to insurers to obtain you a quotation

Please confirm we can contact you by email, telephone, SMS or post with quotations or in respect of any policy you hold with us

From time to time we may also send you communication in relation to other products or services we offer. We never share your email address with any other parties. Please confirm that it is OK to send you marketing information from Dolmen Insurance Brokers Ltd. Please choose below

Motor Trade Enquiry Form

KennCo - Preferred Young Driver Discount Checklist

To obtain you a Quotation we need your Consent

Contact Preference

Marketing Consent