Quotation Request Motor Breakdown - DJB (Motorhome) 1 2 Vehicle 1 3 4 Auto Renewal Complaint Module Cover Details THIS IS DJB QUOTE/SALE Name -- Mr Mrs Miss Ms Dr Prof. Capt. Lord Lady Major Rev. Master Exec(s) of Mx Email AddressYou will use this along with your password to login to your account and to retrieve your quotation should you choose to save it. These details will automatically be emailed to you for your reference. Email you will log in with this Forgot your password? Email enter again Password Password enter again Mobile Telephone -Hidden- Base Rate £ - Hidden - Base Rate 2 £ -Hidden- Quoted ? Bongo? Pajero Bongo Load £ -Hidden- DVLA Model Blank -Hidden- 2nd Veh Rates -Hidden- 3rd Veh Rates -Hidden- 4th Veh Rates - Hidden - Payment Method When would you like cover to commence? 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2024 Level of Cover Silver Gold - Select - Policy Benefits No call out charge Homestart Roadside assistance Nationwide recovery Overnight accommodation Hire car Onward destination Policy WordingClick here to view the policy wording. Policy Benefits No call out charge Homestart Up to 90 days EU cover (maximum of 30 days per trip) Roadside assistance Nationwide recovery Overnight accommodation Hire car Onward destination Policy WordingClick here to view the policy wording. Your First VehicleType of Vehicle Motorhome / Campervan Select the make of your vehicle - select - A.D. TramontanaAC PropulsionAcuraACAJSAlfa RomeoAlpineAmuzaAnterosApriliaArashArielArrineraAscariASLAsterioAston MartinAudiAustinAutocars Co.B EngineeringBACBajajBeijing Automobile WorksBenelliBentleyBertoneBMWBolloreBolwellBrilliance / HuaChenBristolBritish LeylandBRM BuggyBrookeBSABuddyBuforiBugattiBuickBYDCadillacCaparoCarbontechCariceCaterhamChang'anChangheCheryChevroletChevronChryslerCitroenCommerCommuter CarsConnaughtCoviniCupraDaciaDaewooDaihatsuDatsunDe La ChapelleDe TomasoDevonDiardiDMCDodgeDongfengDonkervoortDontoDS AutomobilesDucatiDynasti ElectricE-VadeEagleEffediEgy-Tech EngineeringElectric RaceaboutElfinEmgrandEnglonEquusEternitiEtoxExagonFaralli & MazzantiFAWFerrariFiatFiskerFodayForceFord AustraliaFord GermanyFordFornasariGeelyGeoGibbsGilletGinettaGleagleGMCGonowGreat Wall / ChangchengGrinnallGTA MotorGumpertGWMHafeiHanwayHarley-DavidsonHillmanHindustanHoldenHommellHondaHongqiHradyeshHTT TechnologiesHulmeHumberHusqvarnaHyosungHyundaiICMLIFRImperiaInfinitiInvictaIran KhodroIsderaIsuzuIvecoJACJaguarJeepJensen MotorsJetcarJonwayJOSSKaipanKantankaKawasakiKeewayKiatKiaKish KhodroKoenigseggKorresKTMLadaLamborghiniLambrettaLanciaLand RoverLandwindLarakiLDVLeBlancLeopardLexmotoLexusLi-ionLifanLightningLincolnListerLobiniLocal MotorsLotecLotusLucra CarsLuxgenMahindraMarlinMaruti SuzukiMaseratiMastrettaMazdaMcLarenMercedes-BenzMercuryMGMicroMicrocarMINIMitsubishiMitsuokaMKMorganMullenMycarNash MotorsNissanNobleNotaOpelOptimal EnergyOrcaOtherP.G.O.PaganiPanhardPanozPeranaPeroduaPeugeotPiaggioPlymouthPolarsunPontiacPorscheProtonProtoPuritaliaQorosQvaleRadicalReliantRenaultREVARimacRinspeedRodingRoeweRolls-RoyceRossin-BertinRossionRoverRover GroupRoyal EnfieldSaabSAIC-GM-WulingSAIPASakerSamsungSanSbarroScionScomadiSEATShanghai MapleShelbySingerSinSkodaSmartSpada Vetture SportSpykerSsangyongStreet & Racing TechnologySubaruSunbeamSuzukiSymTalbotTanomTataTauroTawon CarTD CarsTeslaThai RungToyotaTridentTriumphTrollerTrumpchiTushekTVRTVSUEVUltimaUMMUriVauxhallVectorVencerVenturiVEPRVespaVolkswagenVolvoW MotorsWallyscarWestfieldWheegoWiesmannYamahaYES!Youabian PumaZastava AutomobilesZender CarsZenvoZiL Vehicle model Year of manufacture - select - 0123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101189919001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Unfortunately, your vehicle is ineligible, due to being too old for the level of cover selected. We apologise for any inconvenience. Vehicle registration Additional OptionsWould 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 DiscountIf you have a discount code please enter it here: Black Friday Discount Successfully Applied A 5% discount will be applied to your quotation 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 Auto RenewalCan we auto renew the membership? YesNo ComplaintsComplaint Log Date of Incident 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2022 2023 2024 Date of Receipt 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2022 2023 2024 Complaint Method Eligible Complaint? Yes No Pending Referred to FOS? Yes No Pending Category of Complaint Description of Complaint Status Financial Redress Offered (£) £ Accepted? Yes No Pending Closed Date 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2022 2023 2024 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