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QuoteDrop Client Form
If you have any questions, you can contact us on whatsapp or call us directly at 07867379803.
Section 1 - Personal Details
Full Name
*
Date of Birth
*
Email Address
*
Phone Number
*
Section 2 - Address Info
Current Address (Postcode + Full address)
*
Do you also live at another address (parents/uni)? - If Yes, please provide details.
*
Section 3 - Driving & Insurance History
Type of Licence
*
Type of Licence
A
Provisional
B
Full UK
C
Foreign
Date you passed
*
Do you currently have car insurance? If yes, when does it renew, if no, when would you like your cover to start?
*
Any motoring convictions/points in the last 5 years? If yes, give details.
*
Any accidents/claims in last 5 years? If yes, give details.
*
Any No Claims Bonus, if yes, please specify amount
*
Section 4 - Car Details
Car Reg Plate
*
Car Value
*
Date vehicle was purchased
*
Are you the registered keeper?
*
Are you the registered keeper?
A
Yes
B
No
Are you the Legal Owner?
*
Are you the Legal Owner?
A
Yes
B
No
Factory-fit or aftermarket security? (Alarm/Immobiliser/Tracker/Dashcam/None).
*
Any Modifications? If yes, please provide details.
*
Where is the car kept overnight?
*
Section 5 - Usage Details
Annual Mileage
*
Annual Mileage
A
Less than 3,000
B
3,001 - 5,000
C
5,001 – 7,500
D
7,501 – 10,000
E
10,001 – 12,000
F
12,001 – 15,000
G
15,001 – 20,000
H
More than 20,000
Main Usage
*
Main Usage
A
Commute
B
Social
C
Both
Job/Occupation
*
Employment Status
*
Employment Status
A
Full time
B
Part time
C
student
D
self employed
E
unemployed
Home Status
*
Home Status
A
Own
B
Rent
C
Live with Parents
Any DVLA - reported medical conditions?
*
Any DVLA - reported medical conditions?
A
Yes
B
No
Section 6 - Named Drivers
Do you want to add another driver? If yes, please provide their details, if no, please put No in the following boxes instead.
Named driver full name
*
D.O.B
*
Relation
*
Job/Occupation
*
Licence length (in months or years)
*
Convictions/Points
*
Convictions/Points
A
Yes
B
No
Section 8 - Preferences
Would you be open to a black box/telematics policy?
*
Would you be open to a black box/telematics policy?
A
Yes
B
No
C
Not sure
Do you prefer to pay Annual/monthly/no preference.
*
Do you prefer to pay Annual/monthly/no preference.
A
Annual
B
Monthly
C
No preference
What’s the maximum voluntary excess you’d be comfortable paying?
*
What’s the maximum voluntary excess you’d be comfortable paying?
A
£250
B
£500
C
£1000
Referral Code
*
Were you referred by someone? If yes, enter their name or referral code.
Section 10 - Consent & T&C's
I confirm all details are accurate and understand Quotedrop only uses this data to find me the best insurance quotes
*
I confirm all details are accurate and understand Quotedrop only uses this data to find me the best insurance quotes
Yes
I consent to being contacted by QuoteDrop about my quote via email/WhatsApp.
*
I consent to being contacted by QuoteDrop about my quote via email/WhatsApp.
Yes
Payment of the service fee is due once QuoteDrop presents you with verified cheaper quotes that you can use.
*
Payment of the service fee is due once QuoteDrop presents you with verified cheaper quotes that you can use.
Yes
If we cannot find you a cheaper premium than your original quote, no fee is payable.
*
If we cannot find you a cheaper premium than your original quote, no fee is payable.
Yes
QuoteDrop is not an insurance broker. We do not sell policies. We provide an optimisation service to help you identify the lowest available legal premiums.
*
QuoteDrop is not an insurance broker. We do not sell policies. We provide an optimisation service to help you identify the lowest available legal premiums.
Yes
Sign to confirm acknowledgment of T&Cs Above
*
Signature
Submit
