Freeman Mcmurrick Quotation & Proposal Securus Motor Insurance Page 2
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7Vehicle details
Year (YYYY)
Make
Model
Body type
Capacity and cylinders
Registration number
Please select...
Vin/Chassis number
Engine number
Purchase price/value
Purchase date (DDMMYYYY)
Modifications: Means that your vehicle has alterations to the engine, drive train, suspension or wheels other than by the
manufacturers design.
Accessories: An accessory is an item fitted by a dealer or non standard item or items not fitted by the manufacturer, such as tinted
windows, alloy wheels and other fixed items which do not affect the performance or handling of the vehicle.
Has your vehicle been modified?
Yes
No
If yes, describe all modifications and their values.
Does your vehicle have any non-standard accessories?
Yes
No
If yes, describe the accessories and their values.
Do you have a security device fitted to your vehicle?
Yes
No
If yes, please provide details.
How would you rate the overall vehicle condition?
New vehicle
Good for its age condition
Average or less, requires restoration
Classic vehicle – newly restored/concours
Do you wish to insure for your vehicle for
agreed value or
market value
If agreed value, at what value do you wish to insure your vehicle?
$
(Including modifications and accessories i.e. proposed agreed value.)
Are there additional spare parts to be insured at your home location only?
Yes
No
If so please attach an additional sheet to this proposal advising each and their value.
(If we agree to cover, these will be noted on your quote and policy schedule.)
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