George Stubbs

Motor Quotation Request Form

In order to recive your Motor Insurance Quotation request please complete the form below and one of our friendly and helpful staff members will get back to you with the quote.

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* indicates a compulsory field

Details of Driver(s)
      Proposer            -              Driver 2            -              Driver 3            -              Driver 4
* Name:
* Marital Status:
* Sex:
* Post Code:
* No & 1st Line of Address:
* Telephone:
* E-Mail:
* Date of Birth:
* License Type:
* Length held (Years):
* UK resident:
* Years resident:
* Occupation / Business:
If any of the below questions are yes please provide details in space provided below
* Convictions:
* Claims:
* Disabilities:
Additional Information i.e Convictions / Claims etc ...
Details
Details of Vehicle
* Vehicle Registration:
* Make:
* Model:
* Engine Capacity:
* Year of Manufacture:
* Market Value:
* Number of Doors (?):
* Date of purchase:
* Modifications:
* Where kept overnight:
Details of Security:
Who fitted Security:
Cover
* Level of Cover:
Driving restrictions:
* Total Annual Miles:
Business Miles:
Class of Use:
* No Claims Bonus:
NCB protected:
Background Information
Full Details of security devices fitted to vehicle:
Tracker device make/model:
* Is the vehicle garaged?:   Yes    No 
* In a secure compound?:   Yes    No 
Existing Quotes
Current Insurer:
Renewal Premium (£):
Provisional Quote:
Premium:
Excess:
Insurer:
Reference:
Terms & Conditions:
 

The guidance contained within this website is subject to the UK regulatory regime and is therefore primarily targeted at customers in the UK.
George Stubbs Financial Services Ltd is authorised and regulated by the Financial Services Authority. FSA No 457640. Registered in Scotland SC150771. Registered address: 6 Atholl Crescent, Perth, Perthshire, PH1 5JN.
George Stubbs Insurance Services Ltd is authorised and regulated by the Financial Services Authority. FSA No 308729. Registered in Scotland SC177962. Registered address: Sout Inch Business Centre, Shore Road, Perth, Perthshire, PH2 8BW.