Giles - Apply

Taxi cover application form

Please complete the Enquiry Form below and one of our experienced Account Executives will contact you within one working day.

APM REF

Owner Name

Date Of Birth (DDMMYY)

Address

Telephone (landline)

Telephone (mobile)

Hire type Public Private

Experience (years)

Number of seats

Make / Model

Ref (if possible)

Value

Engine size (cc)

Year

Drivers

Council / Borough

Office

No claims bonus type

Protected Yes No

Current Insurer

Renewal Date

Current Premium

Is PL and Data head cover required?

Where did you get our number from?

Please list the details of any additional drivers to be included in the quote

Please list the details of any accidents or claims, making sure to indicate which driver(s) were involved

Please list the details of any convictions, making sure to indicate to which driver(s) these details apply