Al Hakim Auto Insurance
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+44 7787 484769
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Price Searching
Contact Us
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Van Insurance
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Van Insurance
How did you hear about us
*
Select
Word of Mouth
Existing customer
Friend or Family
Email/Newsletter
Social Media
The internet search
If by a friend, family or referrer please state their name
*
This information is solely for our marketing purpose
About You
Title
*
Title
Mr
Mrs
Miss
Dr (male)
Dr (female)
Frist Name
*
Last Name
*
Address (House Number, Street, City)
*
Post Code
*
Were you born in the UK
*
Were you born in the UK
Yes
No
If No, when did you last become a UK resident
*
Date of Birth
*
Marital Status
*
Marital Status
Single
Married
Civil Partner
Cohabiting
Divorced
Separated
Widowed
Employment Status
*
Employment Status
Employed
Unemployed
Self-Employed
House Person
Education
Retired
If Employed/Self Employed, What's your main occupation?
*
If Employed/Self Employed, What industry is this occupation in?
*
Any children under 16
*
Any children under 16
Yes
No
Home owner
*
Home owner
Yes
No
Contact Details
Email
*
Phone
*
Vehicle Details
Vehicle Registration
Date of purchase
*
Manufacturer
*
Select
Abarth
AC
Aixam
Alfa Romeo
Asia
Aston Martin
Audi
Austin
Bentley
BMW
Bristol
Cadillac
Caterham
Chevrolet
Chrysler
Citroen
Coleman Milne
Corvette
Dacia
Daewoo
Daihatsu
Daimler
De Tomaso
Dodge
Eagle
F.S.O.
Ferrari
Fiat
Ford
Honda
Hummer
Hyundai
Infiniti
Isuzu
Jaguar
Jeep
Jensen
Kia
Lada
Lamborghini
Lancia
Land Rover
Lexus
Ligier
Lotus
Marcos
Maserati
Maybach
Mazda
Mercedes-Benz
MG
Microcar
Mini
Mitsubishi
Morgan
Nissan
Noble
Opel
Perodua
Peugeot
PGO
Porsche
Proton
Reliant
Renault
Rolls-Royce
Rover
SAAB
SAO
Seat
Skoda
Smart
Ssangyong
Subaru
Suzuki
Talbot
Tata
TOYOTA
TVR
Vauxhall
Volkswagen
Volvo
Westfield
Yugo
Model
*
Alarms - Immobiliser
*
Select
Factory Fitted Thatcham Approved Alarm/Immobiliser
Factory Fitted Thatcham Approved Alarm
Factory Fitted Non-Thatcham Alarm/Immobiliser
Factory Fitted Non-Thatcham Alarm
Factory Fitted
None
Number of doors
*
Select
3 Doors
5 Doors
Engine Size (CC)
*
Transmission
*
Select
Automatic
Manual
Fuel type
*
Select
Diesel
Petrol
LPG
Other
Body Type
*
Select
Van
Pickup
Light Van
Luton
Box Van
Canteen
Crew Cab
Curtainside
Double Cab
Dropside
Flat Bed
Horsebox
Hot Food Dispenser
Ice Cream Van
Loader
Milk Float
Mobile Shop
Refrigerated / Insulated Van
Tipper
Other
Roof Type
*
Select
Normal Roof
High Roof
Wheel Base
*
Select
Long Wheel Base
Medium Wheel Base
Short Wheel Base
When would you like the policy to start
*
How do you normally pay for insurance?
*
Select
Monthly
In Full
Does the vehicle have any modifications?
*
Yes
No
Is the vehicle kept at the same address
*
Select
Yes
No
If No, what is the full address of where the vehicle is kept
Carriage of dangerous goods
*
Yes
No
Vehicle Usage
Date of purchase
*
Where is the vehicle kept during the day
*
Select
At Home
Office or Factory Car Park
Open public car park
Secure public car park
Street away from home
Where is the vehicle kept overnight
*
Select
Garaged
Public Road
Drive
Private Property
Car Park
Locked Compound
Use of Vehicle
*
Select
Social, domestic, pleasure, commuting (SDPC)
Social, domestic and pleasure only (SDP)
SDPC and business use (proposer/spouse only)
SDPC and business use (any named driver)
SDPC and business use (proposer only)
Estimated Annual Mileage
*
Select
1,000 Miles
2,000 Miles
3,000 Miles
4,000 Miles
5,000 Miles
6,000 Miles
7,000 Miles
8,000 Miles
9,000 Miles
10,000 Miles
11,000 Miles
12,000 Miles
13,000 Miles
14,000 Miles
15,000 Miles
16,000 Miles
17,000 Miles
18,000 Miles
19,000 Miles
20,000 Miles
21,000 Miles
22,000 Miles
23,000 Miles
24,000 Miles
25,000 Miles
26,000 Miles
27,000 Miles
28,000 Miles
29,000 Miles
30,000 Miles
31,000 Miles
32,000 Miles
33,000 Miles
34,000 Miles
35,000 Miles
36,000 Miles
37,000 Miles
38,000 Miles
39,000 Miles
40,000 Miles
41,000 Miles
42,000 Miles
43,000 Miles
44,000 Miles
45,000 Miles
46,000 Miles
47,000 Miles
48,000 Miles
49,000 Miles
50,000+ Miles
Type of Business
*
Select
None
Sole Trader
Limited Company
Partnership
Other
Type of Cover
*
Select
Comprehensive
Third party fire & theft
Third party only
Any no claims discount
*
Select
No NCD
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
17 Years
18 Years
19 Years
20 Years +
How did you earn your no claims discount
*
Select
With this vehicle or a previous vehicle
With a company vehicle
In another country
Was this NCD earned in the UK
*
Select
Yes
No, Earned it the European Union
No, Earned it outside European Union
Would you like to protect your NCD
*
Select
Yes
No
Do you have any other NCD on your private car (if applicable)
*
Select
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
15 Years +
What voluntary excess would you like
*
Select
None
£50
£100
£150
£200
£250
£300
£350
£400
£450
£500
How do you normally pay for insurance?
*
Select
Monthly
In Full
When would you like the policy to start
*
Driving History
Type of License
*
Type of License
Full UK Manual
Full UK Automatic
Provisional UK
Full Euro EEC
Other International
License Number
Period license held for
*
Period license held for
Less than 1 Year
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
17 Years
18 Years
19 Years
20 Years
21 Years
22 Years
23 Years
24 Years
25 Years
25+ Years
What date was license obtained
*
Do you have any non-motoring criminal convictions?
*
Yes
No
Do you have any non-motoring criminal convictions?
Registered Keeper
*
Select
Proposer
Company
Other
Leased Private
Leased Company
Society or Club
Legal Owner
*
Select
Proposer
Company
Other
Leased Private
Leased Company
Society or Club
Any driver insurance declined, cancelled, voided or special terms imposed?
*
Yes
No
Additional Drivers
Would you like to add an additional driver
*
Yes
No
Additional Driver Details
Title
Title
Mr
Mrs
Miss
Dr (male)
Dr (female)
Frist Name
Last Name
Relationship to Proposer
Select
Spouse
Civil Partner
Common Law Partner/Cohabitee
Son/Daughter
Parent
Brother/Sister
Other Family
Employee
Employer
Business Partner
Other
Date of Birth
Marital Status
Marital Status
Single
Married
Civil Partner
Cohabiting
Divorced
Separated
Widowed
Employment Status
Employment Status
Employed
Unemployed
Self-Employed
House Person
Education
Retired
If Employed/Self Employed, What's your main occupation?
Address (House Number, Street, City)
Type of License
Type of License
Full UK Manual
Full UK Automatic
Provisional UK
Other International
Period license held for
Period license held for
Less than
1 Year1
Year2
Years3
Years4
Years5
Years6
Years7
Years8
Years9
Years10
Years11
Years12
Years13
Years14
Years15
Years16
Years17
Years18
Years19
Years20
Years21
Years22
Years23
Years24
Years25
Years25+
Were they born in the UK
Were they born in the UK
Yes
No
If less than 3 years, please advise on date obtained
If No, when did they last become a UK resident
Motor Accidents
Have you had any motor accidents (fault or non-fault) or claims (whether claim made or not) in the last 5 years
*
Yes
No
Motor Accident or Claim Details
Who was driving?
Select
Me
Another Driver
Driver Name
Type
Select
Accident
Explosion
Fire Damage
Lightning Damage
Malicious Damage
Riot Damage
Storm Damage
Theft - Accessories
Theft - Personal Effects
Theft - Sound Equipment
Theft Of Vehicle
Theft Related Damage
Windscreen Only
Date
Damage
Select
Damaged - Amount Known
No Damage
Unknown
Write-Off
Cost(£) - if known
Fault
Select
Both parties
No other vehicle involved
Other party
Our Driver
Unoccupied Vehicle
Any Injuries
Select
Yes
No
Motor Convictions
Have you had any motor convictions, fixed penalties or disqualifications in the last 5 years
*
Yes
No
Motor Conviction, Fixed Penalty or Disqualification Details
Conviction Code
Select
AC10
AC20
AC30
AC99
BA10
BA20
BA30
BA99
CD10
CD20
CD30
CD40
CD50
CD60
CD70
CD80
CD90
CD99
CU10
CU20
CU30
CU40
CU50
CU60
CU80
DD10
DD20
DD30
DD40
DD50
DD60
DD70
DD80
DD90
DR10
DR20
DR30
DR40
DR50
DR60
DR70
DR80
DR90
IN10
LC10
LC20
LC30
LC40
LC50
MS10
MS20
MS30
MS40
MS50
MS60
MS70
MS80
MS90
MS99
MW10
PC10
PC20
PC30
PL10
PL20
PL30
PL40
PL50
SP10
SP20
SP30
SP40
SP50
SP60
TS10
TS20
TS30
TS40
TS50
TS60
TS70
TT99
UT10
UT20
UT30
UT40
UT50
Date
Damage
Select
Damaged - Amount Known
No Damage
Unknown
Write-Off
Points
Select
None
1
2
3
4
5
6
7
8
9
10
11
12
Fine(£) - if any
Ban (months) - if any
Current Insurance Status
Do you currently have insurance?
Select
Yes
No
If Yes
This information is solely for our marketing purpose
This information is solely for our marketing purpose
Additional Information
Additional Comments
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Confirmation of Understanding
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I understand that Sultan Auto Insurance does not make any personal recommendations as to the suitability of the policy to an individual needs or circumstances. I am using their services as technical support to help me search the web and find multiple insurance quotes.
We do not act as a broker or agent for any particular insurance company, we are here for you and only you on behalf of you. Although we cannot give you advice regarding your insurance needs, we can search the market for the best prices on your behalf as long as you provide us with accurate information and you are comfortable with your insurance needs.
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