Motum Insurance Services

Fleet Insurance Quotation

Company/Trading Name

Company Reg No (if applicable)

Phone:

Web Address

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Preferred driver profile

We require information of drivers with any significant motoring offences, i.e. IN10, DR10, CU80, or drivers whom have accumulated more than 7 penalty points within the last 3 years. We will require information of any drivers who have held their licence for less than 12 months.

We require details of any accidents, incidents or insurance claims within the past 5 years. Please confirm if you've had any losses at all

If possible please provide proof of No Claims Bonus or Confirmed Claims Experience (if fleet rated)

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It is important you provide full and accurate information whilst completing this form, failure to do so could result in your policy not covering the cost of a claim. Failure to disclose may invalidate your policy.

Motum Insurance Services

Unit 3 Brooklands Court

Kettering Venture Park

Kettering NN15 6FD

Privacy Notice

Motum Insurance Services is a trading name of Horizon Vehicle Management Ltd. Horizon Vehicle Management Ltd is authorised and regulated by the Financial Conduct Authority (Firm Reference Number 0345 034 4542 in respect of insurance distribution and claims management activities. You can check our status on the Financial Services Register at https://register.fca.org.uk/s/. Registered Office in England at our address Lumaneri House Blythe Gate, Blythe Valley Park, Solihull, West Midlands, United Kingdom, B90 8AH. We are registered in England and Wales (registration number is 0345 034 4542. We are registered with the ICO (registration number ZA0345 034 4542.

It is our intention to provide you with the highest possible level of customer service at all times. However we recognise that things can go wrong on occasion and if this occurs we are committed to resolving matters promptly and fairly. Should you not be satisfied with our final response, you may be entitled to refer the matter to the Financial Ombudsman Service (FOS). More information is available on request or on their website, www.financial-ombudsman.org.uk.