Andrew Copeland Insurance

Overview

Product designed for UK registered vehicles kept in Europe (France, Spain and Portugal).

The vehicle should be kept abroad for 11 months a year.

Annual green card, comprehensive cover available, windscreen cover provided and social, domestic and pleasure use. Underwritten at Lloyd's.

Normal Policy excess is £100.

Please enter the clients name here
Please enter your broker details and the name of the person you would like us to contact with the quote.
First Name	Middle Initial
Last Name	Street Address
E-mail	Address (cont.)
Home telephone number:	City
Work telephone:	Postal Code
Full time occupation:	Employers business:
Part-time occupation (if none please state):	Date of birth:	-- dd/mm/yy
Marital status:

Proposer Details Cover and Use

What cover is required:	Comprehensive Third party fire & theft Third party only
If comprehensive cover is required, do you wish to bear a voluntary own damage excess? This would apply in addition to any compulsory excess imposed:
	£250 excess £500 excess (for vehicles over £20,000)
Period of insurance commencing (date including start time):
Will your vehicle be used solely for social domestic & pleasure purposes only and travel between your home and permanent place of business?	Yes No	Please state any other use of the vehicle:
Protected no claims discount required:	Yes No

Vehicle Details

Registration number		Make, model and type
Type of body		Number of seats
Year of make		Estimated present value
Engine capacity		Original cost and purchase date
What country is the vehicle going to be kept in?		If other please state the country:
Has the vehicle been modified, altered, adapted or is it left hand drive:	Yes No	If yes, please provide full details:
Will the vehicle be kept in a lock-up garage when not in use:	Yes No	If no, please state where car is kept (driveway, road, etc):
Will the car be kept at the proposer's address:	Yes No

Ownership and Drivers

Do you own the vehicle?

Yes No

If no, please provide details of ownership:

Is the vehicle registered in your name?

Yes No

If no, please provide details of registration:

Do you or any member of your family own another vehicle?

Yes No

If yes, please provide details:

Do you or any member of your family have the use of another vehicle?

Yes No

If yes, please provide details:

Who will drive the vehicle?

Yourself only
Yourself & spouse only
Any driver over 25 years old

Give full details below in respect of yourself and ALL others who will drive


Full name	Yourself
Occupation	---
Date of Birth	---
Type of British driving licence held
How long licence held
Years resident in the UK
Main user?

Driving and Medical Record and Claims History

Have you, your spouse, or any other person who will drive the vehicle ...

Previous Insurance and No Claim Discount

Do you hold or have you ever held motor insurance?	Yes No	If yes, please provide full details:
Are you claiming no claim discount?	Yes No	Please state the number of years claim free:

The Underwriters reserve the right to decline any proposal. Liability does not commence until the Proposal is accepted by the Underwriters.

Returning to the United Kingdom. This policy covers insured vehicles when they return to the United Kingdom for a period of up to 28 days during any one period of insurance, as defined in the policy schedule. If this period is exceeded cover will be reduced to the minimum necessary to meet the requirements of the Road Traffic Acts.

OUR CONTACT DETAILS

Andrew Copeland
Insurance Consultants Ltd
230/234 Portland Road,
London SE25 4SL
Tel: 020 8656 2544
Fax: 020 8655 1271
info@acopeland.com

INSURANCE SPECIALISTS

With years of experience behind us, Andrew Copeland Insurance Consultants Ltd are your one stop shop for property insurance.

Andrew Copeland Insurance Consultants Ltd is authorised and regulated by
the Financial Services Authority