Quotation Request

Motor Breakdown - DJB R

Complaint Module

1

Vehicle Details

Make:

Model:

Year of Manufacture:

Registration

-Hidden- Base Rate

- Hidden - Base Rate 2

-Hidden- Quoted ?

-Hidden- 2nd Veh Rates

-Hidden- 3rd Veh Rates

-Hidden- 4th Veh Rates

- Hidden - Payment Method

2

Cover Details

When would you like cover to commence?

3

Would you like to include misfuel cover for your vehicle(s)?

We'll cover you in the event of you fuelling your vehicle with an incorrect fuel type. Should this happen, one of our recovery operators shall attend and drain your vehicle of the incorrect fuel type. We shall also fuel your vehicle with £20 of the correct fuel.

For just £6 per vehicle

YesNo

Would you like to include keycare cover for your vehicle(s)?

In the event of the vehicle's keys being damaged in any way, lost or issue with key fobs or immobiliser keys, we shall recover the vehicle to the nearest garage able to effect a repair.

For just £2.50 per vehicle

YesNo

Would you like to increase your cover to unlimited callouts?

Our standard cover allows you up to 6 callouts within the duration of policy. With our unlimited callouts option this gives you ultimate peace of mind knowing that no matter how often you need us, we will always be there.

For just £3.00 per vehicle

YesNo

4

If you have a discount code please enter it here:

A 10% discount will be applied to your quotation

Declaration

I understand that I will not be able to make a claim under this policy for the first 48 hours from the start date of the policy as I have selected. I also agree to the terms and conditions of the membership as outlined

I hereby declare the details I have submitted to be true and accurate. Also my vehicle, to the best of my knowledge, is in a good state of mechanical and electrical repair, holds a current UK M.O.T. (where applicable) and is road legal

Complaints

Complaint Log

Cover Details

Set + CommissionLift	£		£0.00
Set + Auto Load	£		£0.00
Set + Use Load	@	%	£0.00
Set + MPA Load	@	%	£0.00
Set + Radius Load	@	%	£0.00
Set + Ownership Load	@	%	£0.00
Set + Horsebox Load	@	%	£0.00
Set + Vehicle 2 Use Load	@	%	£0.00
Set + Vehicle 2 MPA Load	@	%	£0.00
Set + Vehicle 2 Radius Load	@	%	£0.00
Set + Vehicle 2 Ownership Loaf	@	%	£0.00
Set + Vehicle 2 Horsebox Load	@	%	£0.00
Set + Vehicle 2 Bongo Load	@	%	£0.00
Set + Vehicle 3 Use Load	@	%	£0.00
Set + Vehicle 3 MPA Load	@	%	£0.00
Set + Vehicle 3 Radius Load	@	%	£0.00
Set + Vehicle 3 Ownership Load	@	%	£0.00
Set + Vehicle 3 Horsebox Load	@	%	£0.00
Set + Vehicle 3 Bongo Load	@	%	£0.00
Set + Vehicle 4 Use Load	@	%	£0.00
Set + Vehicle 4 MPA Load	@	%	£0.00
Set + Vehicle 4 Radius	@	%	£0.00
Set + Vehicle 4 Ownership Load	@	%	£0.00
Set + Vehicle 4 Horsebox Load	@	%	£0.00
Set + Vehicle 4 Bongo Load	@	%	£0.00
Set - Multi Vehicle Discount	@	%	£0.00
Set - Discount	£		£0.00
Set - Adjustment	@	%	£0.00
Set + Misfuel	£		£0.00
Set + Keycare	£		£0.00
Set + Excess	£		£0.00
Set + Unlimited Callouts	£		£0.00


Total Premium (Net)			£0.00

+ VAT	@	%	£0.00
+ Policy Fee	£		£0.00

Total Premium			£0.00

Total Commission			£0.00
(Due From Broker)			£0.00