HGV and Haulage Insurance Enquiry Form

Your details

Your vehicle

Drivers

Your details

Salutation

First name

Surname

Email address

Phone number

Date of Birth

Your address

Your occupation

Your details

Do you have more than one vehicle to insure?

ℹ️ If you have more than one vehicle to insure, you may find our Motor Fleet Insurance more suitable.

Vehicle registration number

Vehicle make

Vehicle model

Purchase date

Vehicle value (£)

Body type

Gross Vehicle Weight (KG)

ℹ️ Our HGV Insurance only covers vehicles above 3,500KG in Gross Vehicle Weight (GVW). If your vehicle weighs less, you might find our Commercial Vehicle Insurance more suitable.

The typical maximum legal Gross Vehicle Weight (GVW) is 32,000KG. If your vehicle is heavier, please contact us to discuss your requirements.

Drivers

Driver restrictions

Who do you want to be able to drive the vehicle?

Driver 1

Full name

Date of Birth

Relationship to the policy holder?

Driver 2

Full name

Date of Birth

Relationship to the policy holder?

Driver 3

Full name

Date of Birth

Relationship to the policy holder?

Driver 4

Full name

Date of Birth

Relationship to the policy holder?

Declarations

Are you able to confirm you (and anyone who will be insured by this policy): *

Has never had a policy voided, cancelled, refused or had special terms applied
Has never had a claim repudiated or refused
Has had no county court judgement (CCJ) served against you or entered into an individual voluntary arrangement in the past 5 years
Has never been a director of a company which went into liquidation, receivership, been the subject of an administration order or declared bankrupt
Has never suffered a disability that has a requirement to contact the DVLA but which has not been reported to the DVLA, or holds a restricted licence
Has not been convicted of any criminal conviction not spent under the Rehabilitation of Offenders Act or have any prosecutions pending

It is likely we can still help you obtain cover.

Please provide as much information as you can

You agree that you have read and understood your Duty of Disclosure

You agree that you have read and agree to our Privacy Policy and Terms, that we can process your information for the purposes of providing a quote, and that we can reply to you.

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Impact Insurance Services (Bolton) Limited are authorised and regulated by the Financial Conduct Authority. Firm Reference Number: 304613.
Registered Address: 67 Chorley Old Road, Bolton BL1 3AJ. Registered in England with company no. 04939219.
Members of the Society of Insurance Broking.

Duty of Disclosure

Where the main use of the contract is private.

Your duty to give information

When applying for or amending your insurance policy, we and / or your insurer will ask a number of questions to assess the risk prior to agreeing cover. It is your duty to ensure that you answer all questions raised by insurers or us honestly and reasonably. These questions are designed to enable us or the insurer to obtain a comprehensive picture of the nature of the risk to be insured, and only by asking such questions and receiving answers which are given honestly and with reasonable care, can we or the insurer be in a position to offer terms which are designed to meet your demands and needs.

The reason why this is vital and extremely important is that if you fail to tell us or the insurer something when asked, or, if you answer carelessly or act deliberately or recklessly in making misrepresentations when answering questions, your policy may leave you with no insurance protection; insurers may not pay a part or all of your claim and may cancel your policy. You may find it difficult to re-arrange cover because you did not tell an insurer everything when asked, and you will have to disclose this fact when you reapply for insurance.

FAILURE TO ANSWER QUESTIONS HONESTLY AND REASONABLY, WHEN ASKED, MAY LEAVE YOU WITH NO COVER AND A CLAIM NOT PAID

Duty of Disclosure

Where the main use of the contract is commercial.

It is your duty to ensure that you provide a fair presentation of the risk to underwriters; the objective of a fair presentation is to give us all the information underwriters might need to quote the premium and decide what terms to apply.

You have a duty to disclose every material circumstance that you know or ought to know after a reasonable search. This applies before the cover is placed, when renewed and if altered at any time during the policy period. A circumstance is material if it would influence the underwriters decision whether to accept the risk, including terms and pricing.

If there is any doubt whether a circumstance is material to this risk, it should be disclosed as failure to disclose may entitle insurers to refuse to pay a claim or apply additional terms or reduce the claim payment.

The point of a fair presentation is that it is far better to declare everything at the time of a quotation than to let the insurer find things out at the time of a claim.

FAILURE TO DISCLOSE THESE FACTS MAY LEAVE YOU WITH NO COVER AND A CLAIM NOT PAID.

HGV and Haulage Insurance Enquiry Form

Your details

Your details

Drivers

Driver 1

Driver 2

Driver 3

Driver 4

Declarations

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What will you need?

Insurance Services

Company Information

Duty of Disclosure

Duty of Disclosure