ADI Insurance For Driving Instructors
Driving Instructor Insurance Quotation (Single Vehicle)
Duty of Disclosure	Please ensure that all questions are answered accurately and that all material facts are disclosed to avoid the possibility of your insurance being invalidated. i have read and understood the duty of disclosure message
Title	Select Title Mr Mrs Miss Ms
First Name
Surname
Address
Postcode
Date of Birth	Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Select 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Marital Status	Select Married Single Seperated Divorced Co-Habiting Civil Partner
Mobile Number
Home Number
Email Address
Instructor Grade	Select Part 2 PDI ADI Ungraded ADI 4 ADI 5 ADI 6
How long instructor (years)	Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Full/Part time	Select Full Time Part Time
Hours instructing per week	Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50+
Enter any other occupations
Have you ever had any of the following	Bankrupcy IVA Insolvancies
Make of Vehicle	Select AC AIXAM ALFA ROMEO ARIEL ASIA ASTON MARTIN AUDI AUSTIN AUTO UNION BENTLEY BMW BUGATTI BUICK CADILLAC CATERHAM CHEVROLET CHRYSLER CITROEN CORVETTE DAEWOO DAIHATSU DAIMLER DATSUN DAX FARBIO FERRARI FIAT FORD GMC HILLMAN HOLDEN HONDA HUMBER HUMMER HYUNDAI ISUZU JAGUAR JEEP JENSEN KIA KOENIGSEGG LAMBORGHINI LANCIA LAND ROVER LEXUS LIGIER LINCOLN LOTUS LTI MARCOS MASERATI MAYBACH MAZDA MERCEDES-BENZ MG MICROCAR MINI MITSUBISHI MITSUOKA MORGAN MORRIS NAC MG NISSAN NOBLE OPEL PAGANI PANTHER PERODUA PEUGEOT PGO PILGRIM PONTIAC PORSCHE PROTON RADICAL RELIANT RENAULT REVA ROLLS-ROYCE ROVER SAAB SANTANA SEAT SEBRING SKODA SMART SPYKER SSANGYONG SUBARU SUNBEAM SUZUKI TATA TIGER TOYOTA TRIUMPH TVR ULTIMA VAUXHALL VOLKSWAGEN VOLVO WESTFIELD WOLSELEY
Model of Vehicle
Trim of Vehicle ie GL, Sport, LX
Year of Vehicle	Select 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Value of Vehicle	Select £1000 £2000 £3000 £4000 £5000 £6000 £7000 £8000 £9000 £10000 £11000 £12000 £13000 £14000 £15000 £16000 £17000 £18000 £19000 £20000 £21000 £22000 £23000 £24000 £25000
Engine Size	Select 599 600 699 700 799 800 900 1000 1100 1149 1200 1242 1248 1250 1300 1349 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400 2500 2600 2700 2800 2900 3000 3100 3200 3300 3400 3500 4000
Fuel Type	Select Petrol Diesel Gas Dual Fuel Other
Registration Number
Dual Controls Fitted	Select Already Fitted Will Not Be Fitted Fitted Within 30 Days
Has the vehicle been written off	Select No never Cat A write off Cat B write off Cat C write off Cat D write off
Owner of Vehicle	Select Policy Holder Spouse Son / Daughter Leasing Company Other
Registered Keeper	Select Policy Holder Spouse Son / Daughter Leasing Company Other
Have you had any accidents   or claims enter details
Have you had any motor convictions   enter   details
No Claims Bonus	Select 0 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years
Is No Claims Bonus	Select Available to Use On Another Car In Spouses Name In Parents Name Company Car
Protected / Guaranteed NCD	Select Required Not Required
Annual Mileage Soccial Use	Select 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 11000 12000 13000 14000 15000 16000 17000 18000 19000 20000 21000 22000 23000 24000 25000
Annual mileage business use	Select 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 11000 12000 13000 14000 15000 16000 17000 18000 19000 20000 21000 22000 23000 24000 25000 26000 27000 28000 29000 30000 31000 32000 33000 34000 35000
Policy Cover	Comprehensive
Date of Cover	Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Select 2010 2011
RenewaI Premium
Current Insurer
Best premium so far
Which insurer/broker is this with
Contacting you	We may wish to contact you for marketing purposes by post email or text - please advise us if this is not ok. Telephone calls may be recorded for training and monitoring purposes. I confirm i have read the customer contact text