In the last 5 years, have you or any regular driver of this vehicle had a claim, accident or car stolen or burnt (even if not reported or not claimed from an insurer)?
brief description, amount and approx month/year

In the last 5 years, have you or any regular driver of this vehicle had their license suspended, cancelled or disqualified or had a good behaviour period or special conditions imposed?
Includes - speeding, accumulation of points, neg/dangerous driving, driving under the influence

In the last 5 years, have you or any regular driver of this vehicle had a driving offence or issued any speeding or traffic infringements (excluding parking fines)?

In the last 5 years, have you or any regular driver of this vehicle been convicted of, charged with or summonsed for offenses relating to any crime involving drugs, dishonesty, arson, injury, fraud, violence, malicious damage or other criminal act?

In the last 5 years, have you or any regular driver of this vehicle had insurance or claims declined, cancelled, refused or had any special conditions imposed?

In the last 5 years, have you or any regular driver of this vehicle been declared bankrupt?

Are there any Learner drivers that will drive the vehicle?

Any drivers with less than 2 years driving experience?

Has your motor vehicle been converted, altered or modified from the manufacturers original specification for the model or series?

In the last 5 years, have you or any regular driver of this vehicle had a claim, accident or car stolen or burnt (even if not reported or not claimed from an insurer)?
brief description, amount and approx month/year

In the last 5 years, have you or any regular driver of this vehicle had their license suspended, cancelled or disqualified or had a good behaviour period or special conditions imposed?
Includes - speeding, accumulation of points, neg/dangerous driving, driving under the influence

In the last 5 years, have you or any regular driver of this vehicle had a driving offence or issued any speeding or traffic infringements (excluding parking fines)?

In the last 5 years, have you or any regular driver of this vehicle been convicted of, charged with or summonsed for offenses relating to any crime involving drugs, dishonesty, arson, injury, fraud, violence, malicious damage or other criminal act?

In the last 5 years, have you or any regular driver of this vehicle had insurance or claims declined, cancelled, refused or had any special conditions imposed?

In the last 5 years, have you or any regular driver of this vehicle been declared bankrupt?

Are there any Learner drivers that will drive the vehicle?

Any drivers with less than 2 years driving experience?

Has your motor vehicle been converted, altered or modified from the manufacturers original specification for the model or series?

In the last 5 years, have you or any regular driver of this vehicle had a claim, accident or car stolen or burnt (even if not reported or not claimed from an insurer)?
brief description, amount and approx month/year

In the last 5 years, have you or any regular driver of this vehicle had their license suspended, cancelled or disqualified or had a good behaviour period or special conditions imposed?
Includes - speeding, accumulation of points, neg/dangerous driving, driving under the influence

In the last 5 years, have you or any regular driver of this vehicle had a driving offence or issued any speeding or traffic infringements (excluding parking fines)?

In the last 5 years, have you or any regular driver of this vehicle been convicted of, charged with or summonsed for offenses relating to any crime involving drugs, dishonesty, arson, injury, fraud, violence, malicious damage or other criminal act?

In the last 5 years, have you or any regular driver of this vehicle had insurance or claims declined, cancelled, refused or had any special conditions imposed?

In the last 5 years, have you or any regular driver of this vehicle been declared bankrupt?

Are there any Learner drivers that will drive the vehicle?

Any drivers with less than 2 years driving experience?

Has your motor vehicle been converted, altered or modified from the manufacturers original specification for the model or series?