Dalal Insurance

Full Name

Company Name (if any)

Contact Number

Business Address

E-Mail

Type of Vehicle

Carrying Capacity / GVM

Trailer Cover Required?

Yes

Truck Details (Year, Make and Model)

Base Operation Postcode

Public Liability Cover Required

Sum Insured (Vehicle Value)

Radius of Operation

Marine Insurance (Goods in Transit Cover)

Registration Number

Type of Goods Carried

Do You Require Finance For The Vehicle?

Yes

Number of Year's Business Established

Name of Current Insurer (if any)

Age of Regular Driver

Number of Years Continuosly Truck Insurance Held

Number of Claims in The Last 5 Years

Number of Year's Truck License Held

Have You or Any Other Driver Had Any of The Following Driving Convictions in The Last 5 Years?

If You Require a Quote For More Than One Vehicle (Fleet), Please List All The Vehicles Below

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