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About your car
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Do you know your car registration?

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Model version

Year of manufacture

Fuel type

Transmission type

Engine size

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What's the estimated value of your car? Information

£ .00

Is your car right or left-hand drive?

Has your car been imported?

Has your car been modified in any way?
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Your Modifications

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Modifications

Please select all relevant modifications from the categories below:

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Accessories

Air Conditioning

Altered Pedal Configuration

Bull Bars

Car Phones

Dashboard Changes

Driving Lights

Emergency Services Blue Light

External Racking

Fog Lamps

High Level Brake Light

Internal Shelving

Modification Due To Disability

Neon Lights

Parking Sensors

Rally Lights

Refrigerated

Removal/Replacement Seats

Roll Bars

Roll Cage

Roof Rack

Satellite Navigation Equipment

Sports Steering Wheel

Spot Lights

Sunroof

Telematics Device

Tinted Windows

Towbar

Upholstery Changes

Water Tank(s)

Wheelchair Clamps/Straps

Wheelchair Lift/Ramp/Winch

Other - Accessories

Body modifications

Additional Windows

Bonnet Bulge

Changed To A Convertible

Door Modification

Fibreglass Panels

Flared Wheel Arches

Flared Wings

Non Standard Bumper

Strengthening Brackets

Other - Body Modifications

Brakes

Braided Brake Hoses

Dual Controls

Uprated Brakes

Other - Brakes

Engine/transmission

After Market Exhaust System Approved For Road Use

Air Filter

Blueprinting

Bored-out Engine

Chipping – Engine Management System Changes

Exhaust System Changes

Gearing Change

LPG Conversion

Miscellaneous Engine Alterations

Nitrous Oxide Kit Fitted

Non Standard Engine

Standard Engine Replacement

Supercharging

Transmission Changes

Turbocharging

Other - Engine/Transmission

Paintwork/stickers

Badges Indicating Increased Performance

Decals/Stickers

Magnetic/Removable Signs

Murals

Non Standard Re-spray

Paint Work – Non Standard

Painted Signs (Greater Than 25% Of Side And Door)

Painted Signs (Under 25% Of Side And Door)

Striped

Other - Paintwork/Stickers

Spoilers/bodykits

Body Kit

Front Spoiler/Airdam

Rear Roof Spoiler

Rear Spoiler/Aerofoil

Rear Valance

Side Skirt/Sills

Other - Spoilers/Bodykits

Suspension and steering

Hand Controls

Suspension Changes

Other - Suspension/Steering

Wheels/tyres

Alloy Wheels (Optional Extra)

Locking Wheel Nuts

Slick Tyres

Wheel Spacers

Wheel Trims

Wheels - Alloy

Wider Tyres

Wider Wheels

Winter Tyres

Other - Wheels/Tyres

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Please input the modifications for your car or select 'No' to 'Has your car been modified in anyway?
What type of alarm or immobiliser does your car have? Information

Is your car fitted with a tracking device?
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Using your car

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When did you purchase your car?

Month

Year

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Who is the legal owner? Information

Who is the registered keeper? Information

What do you use your car for? Information

What will your annual total mileage be? Information

miles

Please fill in the highlighted fields How many miles do you drive on a typical weekday? (excluding weekends)

How many miles do you drive on a typical weekend?

How many miles do you drive each year for other reasons? - i.e Holidays

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How many of these will be used for business purposes? Information

miles

Where is your car kept during the day?

Where is your car kept at night?

Is the car kept at your home address at night?
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Your personal details

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Title

First name

Last name

Marital status

What is your date of birth?
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Month

Year

How long have you lived in the UK for?
Information

Since birth

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Or from:

Month

Year

Are there children under 16 in the household?
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What telephone number can we contact you on? Information

What is your email address? Information

Please confirm your email address

What is your house number/name?

What is your postcode? Information

Please select your address from the list below

Your Address

Flat/Apartment Number Information

House/Building Name Information

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House/Building Number Information

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Street Information

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Area Information

Post Town/City Information

Postcode Information

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Are you a homeowner?
Information

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How many vehicles in your household do you have access to? Information

What's your current employment status?

What type of student are you?

What's your main occupation? Information

What type of business do you work for? Information

Do you have a part time occupation?

Yes No Selected value

What's your part-time occupation? Information

What type of business do you work for? Information

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Enter your registration number	Information

What's the estimated value of your car?	Information

Has your car been modified in any way?	Information

What type of alarm or immobiliser does your car have?	Information

Is your car fitted with a tracking device?	Information

Who is the legal owner?	Information

Who is the registered keeper?	Information

What do you use your car for?	Information

What will your annual total mileage be?	Information

How many of these will be used for business purposes?	Information

What is your date of birth?	Information

How long have you lived in the UK for?	Information

Are there children under 16 in the household?	Information

What telephone number can we contact you on?	Information

What is your email address?	Information

What is your postcode?	Information

Flat/Apartment Number	Information

House/Building Name	Information

House/Building Number	Information

Street	Information

Area	Information

Post Town/City	Information

Postcode	Information

Are you a homeowner?	Information

How many vehicles in your household do you have access to?	Information

What's your main occupation?	Information

What type of business do you work for?	Information

What's your part-time occupation?	Information

What type of business do you work for?	Information

Your driving history

Please enter the following details in order to proceed with your quote.

What type of driving licence do you have?	Information

How many years have you held this licence for?	Information

How many months have you held this licence for?

Do you have any additional driving qualifications?	Information

Do you have any medical conditions that affect your driving?	Information

In the last 5 years, have you had any accidents, claims or damage involving any motor vehicle (even if no claim was made and regardless of blame)?	Information

Yes No Selected value

Please fill in the highlighted fields

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Claims

What was the date of the incident?

What was the type of incident?	Information

What was the cost of the incident?	Information

£ .00

Was this a fault incident?	Information

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In the last 5 years, have you received or have any motoring convictions pending (including fixed penalty endorsements) or been disqualified?	Information

Yes No

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Convictions

Is this conviction still pending?

Yes No Selected value

What was the date of the offence?	Information

Please be aware that if this offence is settled and becomes a conviction before the start date of your policy, you will need to contact us to let us know.

What was the date of the conviction?	Information

Select the type of conviction	Information

If you received any penalty points, how many was this?	Information

If you were fined, how much was this?

£ .00

Were you banned from driving?

Yes No Selected value

What was the length of this ban? (in months)

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Your additional drivers

Please enter the following details in order to proceed with your quote.

Would you like to add any other drivers to your policy?	Information

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Please fill in the highlighted fields

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Their personal details

Title

First Name

Last Name

Marital Status Information

What's their Date of birth? Information

Month

Year

How long have they lived in the UK for?
Information

Since birth

Error message here

Month

Year

What is their relationship to you?

What's their current employment status?

What type of student are you?

What's their main occupation? Information

What's the business type for this occupation? Information

Do they have a part time occupation?

Yes No Selected value

What's their part time occupation? Information

What's the business type for this occupation? Information

Cancel Continue

Marital Status	Information

What's their Date of birth?	Information

How long have they lived in the UK for?	Information

What's their main occupation?	Information

What's the business type for this occupation?	Information

What's their part time occupation?	Information

What's the business type for this occupation?	Information

Their driving history

How many months have they held this licence for?

Do they have use of any other vehicles, not including this one?

In the last 5 years, have they had any accidents, claims or damage involving any vehicle (even if no claim was made and regardless of blame)?	Information

Yes No Selected value

Please fill in the highlighted fields

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Add another

Their Claims

What was the date of the incident?

£ .00

Cancel Add Delete Amend

In the last 5 years have they received or have any motoring convictions pending (including fixed penalty endorsements) or been disqualified.	Information

Yes No Selected value

Please fill in the highlighted fields

Edit
Edit

Add Another

Their Convictions

Is this conviction still pending?

Yes No Selected value

Please be aware that if this offence is settled and becomes a conviction before the start date of your policy, you will need to contact us to let us know.

If they were fined, how much was this?

£ .00

Were they banned from driving?

Yes No Selected value

What was the length of this ban? (months)

Cancel Add Delete Amend

Cancel Amend Add driver

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Your cover details

Please enter the following details in order to proceed with your quote.

At Provident Insurance we only offer comprehensive car insurance. Please confirm that you understand and agree to this below

I agree

When would you like your cover to start? Information

How many years no claims bonus do you have? Information

About your car

You want a quote for...

Car registration:

Which is:

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We're sorry

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Your Modifications

Modifications

Accessories

Body modifications

Brakes

Engine/transmission

Paintwork/stickers

Spoilers/bodykits

Suspension and steering

Wheels/tyres

Using your car

Your personal details

Your Address

Your address is...

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Your driving history

Claims

Convictions

Your additional drivers

Their personal details

Their driving history

Their Claims

Their Convictions

Your cover details