Example                   Answer

Name:                     Patrick Jones

Address:         Greendale

Contact number: 730453

Occupation:

Size of car engine: 1200cc      Type of car:

                                         Manufacturer: Hewton

                                         Model:

                                         Year: 1997

Previous insurance company:    Any insurance claims in the last five years?    

                        Yes

                                         No

                                   If yes, give brief details:

                               Car was in 1999

Example                   Answer

Name:                     Patrick Jones

Name(s) of other driver(s):                  Uses of car: - social

Simon                             

Relationship to main driver:

Start date: 31 January

Recommended Insurance arrangement

Name of company:

Annual cost: $