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Policy Assist – Car Insurance Quote

About You
What's your title?*
- Mr
- Mrs
- Miss
- Ms
- Dr
What's your first name?*
What's your surname?*
What's your email address?*
What's your mobile number?*
What's your date of birth?*
Have you been a UK resident since birth?*
- Yes
- No
When did you become a UK resident?*
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What's your marital status?*
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What's your full-time employment status?*
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What's your occupation (e.g. Teacher or Bank Clerk)?*
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What industry do you work in (e.g. Banking or Education)?*
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Do you have any second or part-time jobs?*
- Yes
- No
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What's your second or your part-time job?*
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What industry is this in?*
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Tell Us Your Postcode
Your Address
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Address 2*
Do you own this property?*
- Yes
- No
How long have you lived at this address?*

About Your Car
Tell us your vehicle's registration number*
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Vehicle registration number*
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Vehicle Manufacturer*
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Vehicle Model*
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Engine Size*
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Year of Manufacture*
What's the current the value of your car?*
When did you buy the car?*
Are you (the policyholder) the legal owner of the car?*
- Yes
- No
Who is the legal owner of the car?*
Please tell us who the legal owner is?*
Are you (the policyholder) the registered keeper of the car? (i.e. the person whose name appears on the V5C log book)?*
- Yes
- No
Who is the registered keeper of the car?*
Please tell us who the registered keeper is?*
Has the car been modified from the manufacturer's standard specification?*
- Yes
- No
Please select the type of modification*
Do you want to add another modification?*
- Yes
- No
Please select the type of modification*
What's the car used for?*
- Social Only
- Social & Commuting
- Business Use
How many miles will the car be driven in the next year?*
Where is the car normally parked overnight?*
- On The Road
- On The Drive
- Garaged
- Other
Please tell us where the car is parked overnight?*

About Your Driving Experience
What type of driving licence do you hold?*
- UK Full
- Automatic Only
- EU Licence
- UK Provisional
When did you pass your driving test?*
When did you get your licence?*
Do you have any DVLA-reportable medical conditions or disabilities?*
- Yes
- No
Does the DVLA know about the medical condition or disability?*
Have you been involved in any motoring accidents, incidents or claims (regardless of fault) or suffered any type of loss in the last 5 years?*
- Yes
- No
Claim 1: What was the date of the claim / incident?*
Claim 1: What type of claim / incident was it?*
Claim 1: Please tell us the type of claim / incident?*
Claim 1: Who was said to be 'at fault' for the accident?*
- I Was At Fault
- The Other Driver
- Both Drivers
Claim 1: Was a claim made against your insurance policy?*
- Yes
- No
Claim 1: Did the claim / incident affect your No Claims Discount?*
- Yes
- No
Do you want to add another claim / incident?*
- Yes
- No
Claim 2: What was the date of the claim / incident?*
Claim 2: What type of claim / incident was it?*
Claim 2: Please tell us the type of claim / incident?*
Claim 2: Who was said to be 'at fault' for the accident?*
- I Was At Fault
- The Other Driver
- Both Drivers
Claim 2: Was a claim made against your insurance policy?*
- Yes
- No
Claim 2: Did the claim / incident affect your No Claims Discount?*
- Yes
- No
Do you want to add another claim / incident?*
- Yes
- No
Claim 3: What was the date of the claim / incident?*
Claim 3: What type of claim / incident was it?*
Claim 3: Please tell us the type of claim / incident?*
Claim 3: Who was said to be 'at fault' for the accident?*
- I Was At Fault
- The Other Driver
- Both Drivers
Claim 3: Was a claim made against your insurance policy?*
- Yes
- No
Claim 3: Did the claim / incident affect your No Claims Discount?*
- Yes
- No
Do you want to add another claim / incident?*
- Yes
- No
Claim 4: What was the date of the claim / incident?*
Claim 4: What type of claim / incident was it?*
Claim 4: Please tell us the type of claim / incident?*
Claim 4: Who was said to be 'at fault' for the accident?*
- I Was At Fault
- The Other Driver
- Both Drivers
Claim 4: Was a claim made against your insurance policy?*
- Yes
- No
Claim 4: Did the claim / incident affect your No Claims Discount?*
- Yes
- No
Have you received any driving related convictions, licence endorsements, fixed penalties or been disqualifications (banned) from driving in the past 5 years or still have pending action involving motoring offences?*
- Yes
- No
Offence 1: What date were you convicted of this offence?*
Offence 1: What offence code was placed on your licence?*
Offence 1: How many penalty points did you receive for this offence?*
Offence 1: Were you banned / disqualified from driving?*
- Yes
- No
Offence 1: How long were you banned / disqualified for?*
Do you want to add another motoring conviction / offence?*
- Yes
- No
Offence 2: What date were you convicted of this offence?*
Offence 2: What offence code was placed on your licence?*
Offence 2: How many penalty points did you receive for this offence?*
Offence 2: Were you banned / disqualified from driving?*
- Yes
- No
Offence 2: How long were you banned / disqualified for?*
Do you want to add another motoring conviction / offence?*
- Yes
- No
Offence 3: What date were you convicted of this offence?*
Offence 3: What offence code was placed on your licence?*
Offence 3: How many penalty points did you receive for this offence?*
Offence 3: Were you banned / disqualified from driving?*
- Yes
- No
Offence 3: How long were you banned / disqualified for?*
Do you want to add another motoring conviction / offence?*
- Yes
- No
Offence 4: What date were you convicted of this offence?*
Offence 4: What offence code was placed on your licence?*
Offence 4: How many penalty points did you receive for this offence?*
Offence 4: Were you banned / disqualified from driving?*
- Yes
- No
Offence 4: How long were you banned / disqualified for?*
Do you have any unspent criminal convictions?*
- Yes
- No

About Your Policy
What cover would you like?*
- Comprehensive
- Third Party, Fire & Theft
- Third Party Only
What date would you like cover to start?*
- Today
- Tomorrow
- Choose A Start Date
Tell us the date would you like cover to start?*
How many years No Claims Discount (NCD) do you have?*
Would you like to protect your No Claims Discount?*
- Yes
- No
How do you normally pay for your car insurance?*
- Annually
- Monthly
Have you or any additional drivers ever had an insurance policy cancelled or declared void by an insurance company?*
- Yes
- No
When was your policy cancelled / declared void?*
Please select the name of the insurance company that cancelled / declared your policy void*
Please type the name of the insurance company that cancelled / declared your policy void*
Why did the insurer cancel / declare your policy void?*
Please tell us the reason the insurance company cancelled / declared your policy void?*
Do you want to add another driver on your policy?*
- Yes
- No

About Your Additional Driver
What's their title?*
- Mr
- Mrs
- Miss
- Ms
- Dr
What's their first name?*
What's their surname?*
What's their date of birth?*
What is this driver's relationship to you?*
Please tell us this driver's relationship to you?*
What's their marital status?*
Have they been a UK resident since birth?*
- Yes
- No
When did they become a UK resident?*
What's their full-time employment status?*
What's their occupation (e.g. Teacher or Bank Clerk)?*
What industry do they work in (e.g. Banking or Education)?*
Do they have a second or part-time job?*
- Yes
- No
What's their second or part-time job?*
What industry is this in?*

About Their Driving Experience
What type of driving licence do they hold?*
- UK Full
- Automatic Only
- EU Licence
- UK Provisional
When did they pass their driving test?*
When did they get their licence?*
Do they have any DVLA-reportable medical conditions or disabilities?*
- Yes
- No
Does the DVLA know about the medical condition or disability?*
Does this driver have their own vehicle?*
- Yes
- No
Has this driver been involved in any motoring accidents, incidents or claims (regardless of fault) or suffered any type of loss in the last 5 years?*
- Yes
- No
Claim 1: What was the date of the claim / incident?*
Claim 1: What type of claim / incident was it?*
Claim 1: Please tell us the type of claim / incident?*
Claim 1: Who was said to be 'at fault' for the accident?**
- Our Driver
- The Other Driver
- Both Drivers
Claim 1: Was a claim made against your named driver's insurance policy?*
- Yes
- No
Claim 1: Did the claim / incident affect their No Claims Discount?*
- Yes
- No
Do you want to add another claim / incident for this driver?*
- Yes
- No
Claim 2: What was the date of the claim / incident?*
Claim 2: What type of claim / incident was it?*
Claim 2: Please tell us the type of claim / incident?*
Claim 2: Who was said to be 'at fault' for the accident?*
- Our Driver
- The Other Driver
- Both Drivers
Claim 2: Was a claim made against your named driver's insurance policy?*
- Yes
- No
Claim 2: Did the claim / incident affect their No Claims Discount?*
- Yes
- No
Do you want to add another claim / incident for this driver?**
- Yes
- No
Claim 3: What was the date of the claim / incident?*
Claim 3: What type of claim / incident was it?*
Claim 3: Please tell us the type of claim / incident?*
Claim 3: Who was said to be 'at fault' for the accident?**
- Our Driver
- The Other Driver
- Both Drivers
Claim 3: Was a claim made against your named driver's insurance policy?*
- Yes
- No
Claim 3: Did the claim / incident affect their No Claims Discount?*
- Yes
- No
Has this driver received any driving related convictions, licence endorsements, fixed penalties or been disqualifications (banned) from driving in the past 5 years or still have pending action involving motoring offences?*
- Yes
- No
Offence 1: What date were they convicted of this offence?*
Offence 1: What offence code was placed on their licence?*
Offence 1: How many penalty points did they receive for this offence?*
Offence 1: Were they banned / disqualified from driving?*
- Yes
- No
Conviction 1 - How long were they banned / disqualified for?*
Do you want to add another motoring conviction / offence for this driver?*
- Yes
- No
Offence 2: What date were they convicted of this offence?*
Offence 2: What offence code was placed on their licence?*
Offence 2: How many penalty points did they receive for this offence?*
Offence 2: Were they banned / disqualified from driving?*
- Yes
- No
Offence 2: How long were they banned / disqualified for?*
Do you want to add another motoring conviction / offence for this driver?*
- Yes
- No
Offence 3: What date were they convicted of this offence?*
Offence 3: What offence code was placed on their licence?*
Offence 3: How many penalty points did they receive for this offence?*
Offence 3: Were they banned / disqualified from driving?*
- Yes
- No
Offence 3: How long were they banned / disqualified for?*
Does this driver have any unspent criminal convictions?*
- Yes
- No

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Prefer To Call Us?

You can call us for a quote on:

0203 004 8585

Opening hours:

Monday - Friday 9am - 5.30pm
Saturday 9am - 1pm
Sunday Closed

Our Address

Office 5
2nd Floor
24 Windsor Place
Cardiff
CF10 3BY

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Policy Assist Limited is authorised and regulated by the Financial Conduct Authority under Firm Reference No. 648090.
We are registered as a Data Controller with the Information Commissioner's Office, under Registration Number: ZA167493.
Registered in England & Wales under company registration number 08062459.
Registered Address: Office 5, 2nd Floor, 24 Windsor Place, Cardiff, South Glamorgan, CF10 3BY.

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