Quotation Request

Acorn Direct Commercial Vehicle

Your Details

Additional Driver

Vehicle Details

Your Cover

Calculated Fields

Your Details

Is the Proposer an Individual or Company

Individual Company

Please enter Company name

Main Contact at Company

Please enter your Full Name

Please enter your Address

Enter Your POSTCODE and select 'GET ADDRESS' to search.

            UDPRN
        
            UPRN
        
            Organisation
        
            Line 1
        
            Line 2
        
            Town/City
        
            County

Postcode

Please enter your Date of Birth

What is your Marital Status?

Please select your current Occupation

Use Keywords e.g. Taxi Driver, Delivery Driver, Picture Framer

If you are unable to find your occupation, please select the closest match.

What Industry do you work in?

e.g. Insurance, Banking, Engineering.

Do you have a second Occupation ?

YesNo

Please select your 2nd Occupation

Use Keywords e.g. Taxi Driver, Delivery Driver, Picture Framer

If you are unable to find your occupation, please select the closest match.

What Industry is this?

e.g. Insurance, Banking, Engineering.

Have you lived in the UK since Birth?

YesNo

Date UK Resident Since

Date of UK Residency

Your Licence type?

Use for Main Driver ?

When did you pass your Driving Test ?

Do you own your own home ?

YesNo

Please Indicate

Driving Licence Number

Contact Number

*Required for the Claims Process

Client Email Address

Driving History

Have you or any person who to your knowledge will drive;

a) Have you had any driving convictions in the last five years ?

YesNo

Please give details of Motoring Offences

when using a mobile phone, please scroll sideways to enter details.

Conviction Code	Points	Fine	Date of Offence	Date of Conviction

b) Have you been Disqualified from Driving ?

YesNo

Please give details of disqualification/revocation

c) Do you have any Criminal Convictions (including pending) ?

YesNo

Please give details of Criminal Convictions

d) Have you ever had insurance, refused, cancelled, declined or had any special terms imposed?

YesNo

e) Do you have any Medical Conditions (Notifiable to DVLA) ?

YesNo

f) Have you had any claims in the last 3 years ?

YesNo

Please give details of any Accidents / Claims

when using a mobile phone, please scroll sideways to enter details.

Date	Claim Amount	Incident Type	At Fault ?

Rateable Offence Score

Occupation Check (HIDDEN)

Second Occupation Rate (HIDDEN)

Second Employers Business Rate (HIDDEN)

Criminal Conviction Check (HIDDEN)

Total Number of Claims

Prop_ClaimsCount

Acceptable Conviction Check

Prop_MotConvCheck

Additional Driver

Enter the Additional Driver's First Name

Enter the Additional Driver's Surname

Please enter Additional Driver's Address

Enter the drivers POSTCODE and select 'GET ADDRESS' to search.

            UDPRN
        
            UPRN
        
            Organisation
        
            Line 1
        
            Line 2
        
            Town/City
        
            County

Postcode

Please enter the Additional Driver's Date of Birth

Please select the Additional Driver's Marital Status

What is the Additional Driver's Occupation ?

Use Keywords e.g. Taxi Driver, Delivery Driver, Picture Framer

If you are unable to find your occupation, please select the closest match.

Additional Driver's Employers Business Type

e.g. Insurance, Banking, Enginneering.

Does the driver have a second Occupation ?

YesNo

Please select the second drivers other Occupation

Use Keywords e.g. Taxi Driver, Delivery Driver, Picture Framer

If you are unable to find your occupation, please select the closest match.

What Industry is this?

e.g. Insurance, Banking, Engineering.

Has the Driver lived in the UK since Birth?

YesNo

Please enter the Date the Driver moved to the UK

What is the Driver's Licence Type

Please enter the Driver's Driving Licence Number

What Date Did The Driver Pass Their Test

Driving History

Have you or any person who to your knowledge will drive;

a) Does the driver have any driving convictions in the last five years ?

YesNo

Please give details

when using a mobile phone, please use your finger to scroll sideways to enter details.

Conviction Code	Points	Fine	Date of Offence	Date of Conviction

b) Has the driver ever been Disqualified from Driving ?

YesNo

Please give details of disqualification/revocation

c) Does the driver have any Criminal Convictions (including pending) ?

YesNo

Please give details of Criminal Convictions

d) Has the driver ever had insurance, refused, cancelled, declined or had any special terms imposed ?

YesNo

e) Does the driver have any Medical Conditions (Notifiable to DVLA) ?

YesNo

f) Has the driver had any claims in the last 3 years ?

YesNo

Please give details of any Accidents / Claims

when using a mobile phone, please use your finger to scroll sideways to enter details.

Date	Claim Amount	Incident Type	At Fault ?

Driver 1 Occupation Check (HIDDEN)

Second Occupation Rate (HIDDEN)

Second Employers Business Rate (HIDDEN)

Criminal Conviction Check (HIDDEN)

Total Number of Claims

Dri1_ClaimsCount

Acceptable Conviction Check

Dri1_MotConvCheck

2nd Additional Driver Details

Enter the Additional Driver's First Name

Enter the Additional Driver's Surname

Please enter Additional Driver's Address

Enter the drivers POSTCODE and select 'GET ADDRESS' to search.

            UDPRN
        
            UPRN
        
            Organisation
        
            Line 1
        
            Line 2
        
            Town/City
        
            County

Postcode

Please enter the Additional Driver's Date of Birth

Please select the Additional Driver's Marital Status

What is the Additional Driver's Occupation ?

Use Keywords e.g. Taxi Driver, Delivery Driver, Picture Framer

If you are unable to find your occupation, please select the closest match.

Additional Driver's Employers Business Type

e.g. Insurance, Banking, Enginneering.

Does the driver have a second Occupation ?

YesNo

Please select the drivers 2nd Occupation

Use Keywords e.g. Taxi Driver, Delivery Driver, Picture Framer

If you are unable to find your occupation, please select the closest match.

What Industry is this?

e.g. Insurance, Banking, Engineering.

Has the Driver lived in the UK since Birth?

YesNo

Please enter the Date the Driver moved to the UK

Please select the Driver's Licence Type

Please enter the Driver's Driving Licence Number (Optional)

What Date Did The Driver Pass Their Test

Driving History

Have you or any person who to your knowledge will drive;

a) Does the driver have any driving convictions in the last five years ?

YesNo

Please give details

when using a mobile phone, please use your finger to scroll sideways to enter details.

Conviction Code	Points	Fine	Date of Offence	Date of Conviction

b) Has the driver ever been Disqualified from Driving ?

YesNo

Please give details of disqualification/revocation

c) Does the driver have any Criminal Convictions (including pending) ?

YesNo

Please give details

d) Has the driver ever had insurance, refused, cancelled, declined or had any special terms imposed ?

YesNo

e) Does the driver have any Medical Conditions (Notifiable to DVLA) ?

YesNo

f) Has the driver had any claims in the last 3 years ?

YesNo

Please give details of any Accidents / Claims

when using a mobile phone, please use your finger to scroll sideways to enter details.

Date	Claim Amount	Incident Type	At Fault ?

Driver 2 Occupation Check (HIDDEN)

Second Occupation Rate (HIDDEN)

Second Employers Business Rate (HIDDEN)

Criminal Conviction Check (HIDDEN)

Total Number of Claims

Dri2_ClaimsCount

Acceptable Conviction Check

Dri2_MotConvCheck

3rd Additional Driver Details

Enter the Additional Driver's First Name

Enter the Additional Driver's Surname

Please enter Additional Driver's Address

Enter the drivers POSTCODE and select 'GET ADDRESS' to search.

            UDPRN
        
            UPRN
        
            Organisation
        
            Line 1
        
            Line 2
        
            Town/City
        
            County

Postcode

Please enter the Additional Driver's Date of Birth

Please select the Additional Driver's Marital Status

What is the Additional Driver's Occupation ?

Use Keywords e.g. Taxi Driver, Delivery Driver, Picture Framer

If you are unable to find your occupation, please select the closest match.

Additional Driver's Employer's Business Type

e.g. Insurance, Banking, Enginneering.

Does the driver have a second Occupation ?

YesNo

Please select the drivers 2nd Occupation

Use Keywords e.g. Taxi Driver, Delivery Driver, Picture Framer

If you are unable to find your occupation, please select the closest match.

What industry is this in ?

e.g. Insurance, Banking, Engineering.

Has the Driver lived in the UK since Birth?

YesNo

Please enter the Date the Driver moved to the UK

Please select the Driver's Licence Type

Please enter the Driver's Driving Licence Number

What Date Did The Driver Pass Their Test

Driving History

Have you or any person who to your knowledge will drive;

a) Does the driver have any driving convictions in the last five years ?

YesNo

Please give details

when using a mobile phone, please use your finger to scroll sideways to enter details.

Conviction Code	Date of Offence	Date of Conviction

b) Has the driver ever been Disqualified from Driving ?

YesNo

Please give details of disqualification/revocation

c) Does the driver have any Criminal Convictions (including pending) ?

YesNo

Please give details

d) Has the driver ever had insurance, refused, cancelled, declined or had any special terms imposed ?

YesNo

e) Does the driver have any Medical Conditions (Notifiable to DVLA) ?

YesNo

f) Has the driver had any claims in the last 3 years ?

YesNo

Please give details of any Accidents / Claims

when using a mobile phone, please use your finger to scroll sideways to enter details.

Date	Claim Amount	Incident Type	AtFault?

Driver 3 Occupation Check (HIDDEN)

Driver 3 Second Occupation Rate (HIDDEN)

Driver 3 Second Employers Business Rate (HIDDEN)

Driver 3 Criminal Conviction Check (HIDDEN)

Total Number of Claims

Dri3_ClaimsCount

Acceptable Conviction Check

Dri3_MotConvCheck

Vehicle Details

Please enter your Vehicle Registration

Please enter full vehicle registration and select OK to search

Select Body Type of Vehicle

What is the current Vehicle Value (£) ?

Please select your annual personal mileage

Please select your annual business mileage

When was the Vehicle Purchased ?

Is the vehicle an import?

YesNo

Where is the vehicle kept overnight?

Vehicle Security

Has the vehicle been modified?

YesNo

Please enter any modifications

Vehicle Modification

Who is the registered owner of the vehicle

Who is the registered keeper of the vehicle

Vehicle Age In Years

Length Of Vehicle Ownership (Months)

Vehicle Value Conversion (HIDDEN)

Body Type Check (HIDDEN)

Body Weight Check (HIDDEN)

Vehicle Value Check

Vehicle Modifications Check

Your Cover

How many years no claims do you have ?

Maximum Business Radius

Based on the location you keep the vehicle overnight

Greater Than 100 MilesLess/Equal to 100 Miles

Would you like to Protect your NCB?

YesNo

Please select voluntary excess

Permission to contact you regarding this quote?

Do we have permission to contact you with the information you have provided to discuss your recent quote?

YesNo

Cover Level Check (HIDDEN)

Cover Details

Set Homeowner	@	%	£0.00
Set Vehicle Age	@	%	£0.00
Set Vehicle Value	@	%	£0.00
Set Number of Seats	@	%	£0.00
Set Period Owned	@	%	£0.00
Set Vehicle Use	@	%	£0.00
Set NCDProtection	@	%	£0.00
Set Overnight Location	@	%	£0.00
Set Body Type	@	%	£0.00
Set Body Weight	@	%	£0.00
Set No Claims Bonus	@	%	£0.00
Set VoluntaryXS	@	%	£0.00
Set Voluntary Maximum	£		£0.00
Set Minimum Premium	£		£0.00
Set Step1	£		£0.00
Set Step2	£		£0.00
Set Broker Load	@	%	£0.00

Calculated Fields

Postcode

Postcode2

Area

Postcode Flex Area

Base Rate

Area Load

Driving Restriction Load

DrivingRestrictionLoad

Base Rate x Area x Driving Restriction

Base Rate HRD Premium

BaseRateDriver

Age

PC_DriverAge

Vehicle Group

NewABICodeGroup

Abi code

Occ Refer

Proposer Details

Proposer Age

PropAge

Proposer Residency Years

ResidencyYears

Employers Business Check

Prop_EmpBusCheck

Proposer Use Refer

Proposer Licence Held Years

PropLicenceHeld

Proposer Licence Type Refer (HIDDEN)

Total Score For Offences (HIDDEN)

Total Proposer Claims Score (HIDDEN)

Proposer Driver Excess

Proposer Load

Proposer Age Load

ProposerAgeLoad

Proposer Residency Load

ProposerResidencyLoad

Proposer Occupation Load

ProposerOccupationLoad

Proposer Employers Business Load

Proposer Marital Status Load

Proposer Licence Type Load

Proposer Licence Held Load

ProposerConvictionLoad

Proposer Accident Load

Proposer Disqualified Load

Proposer Use Load

Proposer Premium

Additional Driver 1

Additional Driver 1 Age

Additional Driver 1 Residency

Additional Driver 1 Licence Held

Employers Business Check

Driver 1 Licence Type Refer (HIDDEN)

Total Score For Offences - DR1 (HIDDEN)

Total Score For Claims - DR1 (HIDDEN)

Driver 1 Excess

Additional Driver 1 Load

Additional Driver 1 Age Load

Additional Driver 1 Residency Load

Additional Driver 1 Occupation Load

Additional Driver 1 Marital Load

Additional Driver 1 Employee Business Load

Additional Driver 1 Licence Type Load

Additional Driver 1 Licence Held Load

AD1ConvictionLoad

Additional Driver 1 Accident Load

Additional Driver 1 Disqualified Load

Additional Driver 1 Use Load

Additional Driver 1 Premium

DR1Premium

Additional Driver 2

Additional Driver 2 Age

Additional Driver 2 Residency

Additional Driver 2 Employee Business

Additional Driver 2 Licence Held

Driver 2 Employers Business Check

Driver 2 Licence Type Refer (HIDDEN)

Total Score For Offences - DR2

Total Score For Claims - DR2

Driver 2 Excess

Additional Driver 2 Load

Additional Driver 2 Age Load

Additional Driver 2 Residency Load

Additional Driver 2 Occupation Load

DR 2 Marital Load

Additional Driver 2 Employee Business Load

Additional Driver 2 Licence Type Load

Additional Driver 2 Licence Held Load

AD2ConvictionLoad

Additional Driver 2 Accident Load

Additional Driver 2 Disqualified Load

Additional Driver 2 Use Load

Additional Driver 2 Premium

DR2Premium

Additional Driver 3

Additional Driver 3 Age

Additional Driver 3 Residency

Additional Driver 3 Employee Business

Additional Driver 3 Licence Held

Driver 3 Employers Business Check

Additional Driver 3 Licence Type

Total Score For Offences - DR3

Total Score For Claims - DR3

Driver 3 Excess

Additional Driver 3 Load

Additional Driver 3 Age Load

Additional Driver 3 Residency Load

Additional Driver 3 Occupation Load

Additional Driver 3 Employee Business Load

Additional Driver 3 Marital Load

Additional Driver 3 Licence Type Load

Additional Driver 3 Licence Held Load

AD3ConvictionLoad

Additional Driver 3 Accident Load

Additional Driver 3 Disqualified Load

Additional Driver 3 Use Load

Additional Driver 3 Premium

DR3Premium

HRD Age

HRD Age Mapped

Mods Refer

Ownership Refer

Vehicle Keeper Quote or Refer

Vehicle Location Refer

Vol XS Load

Vol XS Max Discount

Vehicle Purchased Months

Highest Rated Driver Premium

Minimum Premium

CCMinPrem

Minimum Net of Additions

CCMinPremNet

Vol/Increase XS selected?

Aqua_IncreasedXS

Vol XS Balance

Deduction of Max Vol Balaace

Maximum Voluntary Discount (£)


Total Premium (Net)			£0.00

+ IPT	@	%	£0.00
+ Policy Fee	£		£92.50

Total Premium			£0.00

Total Commission			£0.00
(Due From Broker)			£0.00