Quinn Bros., Longford.
   
 

 

 

 



M O T O R    I N S U R A N C E

Does your motor policy include driving other vehicles, bonus protection or windscreen cover? remember the cheapest policy is not always the best policy.

BUSINESS INSURANCE QUOTATION

Please fill in the form below, selecting which insurance cover you require. Our staff will deal with your request immediately.

Please Note: We cannot give insurance quotations outside the Republic of Ireland.

Motor Insurance Quotation Form
PERSONAL DETAILS
Name
Address
Tel. (Home)
Tel.(Work)
E-Mail
Occupation
Date of Birth
Drinker    Non-Drinker
 
LICENSE
License Type Full Provisional
How Long Held
CAR
Make of Car
Model
Year of Manufacture
Value
Reg. No.
Petrol/Diesel
Engine Size (CC)
Carrying Capacity
Estimated Annual Mileage
INSURANCE DETAILS
Current Insurers
Current Quotation (Optional)
Do you have a 'No Claim Bonus' ? YES   NO
If YES, how many years bonus?  
If NO, have you been a named driver?

YES   NO

For how long?   

     
Is the Car for business use? YES   NO
Renewal Date of Present Policy
Cover Required: Comprehensive
Third Party, Fire & Theft
Third Party
ADDITIONAL DRIVERS
Name1
Relationship to Proposer
Date of Birth
License Type Full Provisional
How Long Held
Occupation
   
Name2
Relationship to Proposer
Date of Birth
License Type Full Provisional
How Long Held
Occupation

Brief Details of any Claims in Past 5 Years & Full Details of driving convictions

Have you any illnesses or disabilities? If Yes, please give details.

   

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Patrick J. Quinn t/a Quinn Insurance Services is regulated by the Central Bank of Ireland as an authorized adviser.
Tel: 00 353 43 46237 Fax: 00 353 43 46082 Quinn Bros, Main St, Longford, Ireland. Email: info@quinnbros.ie