Horsebox Insurance
Tel: 01992 718666

Telephone 01992 718666 or email us for a quote
Horsebox

To obtain a quote, please complete the following, and press the "Submit Request" button at the bottom of the form. We will contact you by telephone or email with a quote.
email Address
Confirm email Address  
Title
First Name
Surname
House Number/Name
Street
Town
County
Post Code
Country
Tel. Number - Day
Tel. Number -Evening
Date of Birth
DD/MM/YY
Occupation
Occupation Business Type
How Many Years Have You Held a Full Car Driving Licence
Where Did You See Us Advertised
Existing Customer (Any Product) YES NO 
Vehicle Details:  
Make & Model
Engine Capacity
Year of Manufacture
Date Purchased
Registration Number
Value
Gross Weight
HGV/Non HGV
Living Accommodation
Alarm/Immobiliser
Is a Tracker fitted YES NO 
Cover Required
Present Insurers
Renewal Premium
Renewal Date
No Claim Discount on Horsebox
If this is your first policy for a Horsebox, how many years No Claim Discount do you have for a private car.
Has the Driver suffered a Loss/Made a Claim within the last 5 years in respect of any motor vehicle YES NO 


If YES, give details of Loss or Claim

(pressing 'enter' at the end of each line)
Has the Driver any Motor/Fixed Penalty Convictions or Pending Prosecutions in the last 5 years YES NO 

If YES, give details

(pressing 'enter' at the end of each line)
   
Drivers
Named Driver:  
Title
First Name
Surname
Occupation
Age
How Many Years Have They Held a Car Driving Licence
Has the Named Driver suffered a Loss/Made a Claim within the last 5 years in respect of any motor vehicle YES NO 

If YES, give details of Loss or Claim

(pressing 'enter' at the end of each line)
Has the Named Driver any Motor/Fixed Penalty Convictions or Pending Prosecutions in the last 5 years YES NO 

If YES, give details

(pressing 'enter' at the end of each line)
   
Declaration: I declare that the information I have given above is true and complete. I have not withheld any material facts (see IMPORTANT NOTES.) I agree that this proposal shall form the basis of the Contract between me and Shearwater Insurance.
Shearwater Insurance Services Ltd
Registered Office: 2 Bath Place, London, EC2A 3JJ. Registered in the UK Company No: 02701633