Impounded Vehicle

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REGISTRATION *

Please enter your vehicle registration.

Are you the Legal Owner and Registered Keeper of the vehicle?

The owner is the person who bought the vehicle or the person who has been gifted the vehicle. Proof of vehicle ownership (V5 registration document) is required to be able to release the vehicle!

Unfortunately, we can only provide Impounded Vehicle Insurance if you are the Legal Owner and Registered Keeper of the vehicle.

VEHICLE DETAILS

Vehicle Make & Model *

Purchase Date

You can find this information on the V5 document.

Estimated Value *

If the vehicle is written off/stolen, the insurer will usually pay out the market value. Therefore, this value is not necessarily the amount you'll receive in the event of a claim.

Imported Vehicle? *

Is the Vehicle Modified? *

Right Hand Drive? *

VEHICLE USAGE

Vehicle Usage *

Overnight Vehicle Location *

DRIVER DETAILS

Title *

Name *

First

Last

Your Date Of Birth *

Marital Status *

Your Occupation *

Occupation Status *

Resident in the UK Since *

CONTACT

Phone *

Why do I need to enter a phone number? We may need to contact you to discuss your policy or discuss your insurance needs before you buy (this is a free service and completely optional).

Email *

We will need to contact you via email to provide you with a written quotation.

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

DRIVING LICENCE

Licence Type *

Please note: If you are an International Licence holder, your licence is only valid in the UK for 12 months from the date you arrived in the United Kingdom. The same applies if you are an EU Licence holder that initially passed your driving test outside the EEC!

Licence Valid From *

This is the date you passed your driving test. You can find this information on section 10 of your driving licence.

CLAIMS

Have you had any CLAIMS in the last 5 years, regardless of blame? *

CLAIM 1

Were you at Fault? *

A fault claim is when you are either considered to be to blame for an accident, or your insurer cannot recover their costs from someone else. A fire or theft is usually classed as a Fault Claim! A non-fault claim is when you're involved in an accident that you aren't to blame for and your insurer recovers their costs from a third-party.

Type of Claim *

Please select the claim type that applies in these circunstances

Claim/Incident Date *

Claim Total Cost *

Any more claims in the last 5 years regardless of blame? *

CLAIM 2

Were you at Fault? *

Type of Claim *

Please select the claim type that applies in these circunstances

Claim/Incident Date *

Claim Total Cost *

Any more claims in the last 5 years regardless of blame? *

CLAIM 3

Were you at Fault? *

Type of Claim *

Please select the claim type that applies in these circunstances

Claim/Incident Date *

Claim Total Cost *

CONVICTIONS

Have you had CONVICTIONS in the last 5 Years? Including Pending Conviction! *

CONVICTION 1

Conviction Code *

You can find details of any motoring convictions (fixed penalty for motoring offences) on your driving licence summary by visiting www.gov.uk/view-driving-licence. Please note some convictions may only show on DVLA for 4 years, therefore please ensure you provide conviction details for the last 5 years.

Conviction Date *

Is the conviction pending? *

A pending conviction is when a person has been charged by the police with a crime but has not been found guilty.

Penalty Points *

Fine *

Months Disqualified *

Have you had any more CONVICTIONS in the last 5 Years? *

CONVICTION 2

Conviction Code *

Conviction Date *

Is the conviction pending?

A pending conviction is when a person has been charged by the police with a crime but has not been found guilty.

Penalty Points *

Fine *

Months Disqualified *

Have you had any more CONVICTIONS in the last 5 Years? *

CONVICTION 3

Conviction Code *

Conviction Date *

Is the conviction pending? *

A pending conviction is when a person has been charged by the police with a crime but has not been found guilty.

Penalty Points *

Fine *

Months Disqualified *

NON-MOTORING CONVICTIONS

Have you been convicted of or charged with but not yet tried for a criminal offence other than a motoring offence been convicted of or charged with but not yet tried for a criminal offence other than a motoring offence?

OFFENSE DETAILS

Sentence date *

Crime *

Please type the crime you were convicted

Sentence Type *

Lenght of Sentence *

Please enter the lenght of your sentence in months

Release Type *

Release Date *

IMPORTANT INFORMATION

Have you previously taken a short term policy (for 30 days or less) for a vehicle that had been impounded? *

Declared bankrupt or insolvent either as private individuals or in connection with any business? *

Or had an insurance contract cancelled or declared void or a claim repudiated or renewal refused due to breach of a policy condition or due to non-disclosure or mis-description or misrepresentation of a material fact? *

REVIEW YOUR POLICY

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DATABASE CHECKS

To ensure our insurers and credit providers have the necessary facts to assess your insurance risk, verify your identity, to help prevent fraud, and provide you with their best premium and payment options, they may obtain information from third parties at quotation and renewal and in certain circumstances where policy amendments are requested.

This information includes a quotation search from a credit referencing agency. This search will appear on your credit report and will be visible to other credit providers. To ensure our insurers and credit providers have the necessary facts to assess your insurance risk, verify your identity, help prevent fraud, and provide you with their best premium and payment options, they may obtain information from third parties at quotation and renewal and in certain circumstances where policy amendments are requested. This information includes a quotation search from a credit referencing agency. This search will appear on your credit report and will be visible to other credit providers. It will be clear that this is a quotation rather than a credit application by you to pay in monthly installments.

Field #75 (copy) *

I Agree

TERMS OF BUSINESS

A quotation will be provided based on the information you have disclosed.
Information will be provided so that you can make an informed decision whether this product is right for you and enable you to make your own choice on how to proceed.
We do not offer any advice or recommendation.
Please take care to read the questions carefully, answer them honestly and to the best of your knowledge using the information and help text provided.
Failure to provide accurate information could invalidate your policy and lead to cancellation or may not cover you in the event of a claim.

I have read, reviewed, and agree with UK Sure Terms of Business Agreement and UK Sure Privacy Notice

Disclaimer *

I Confirm

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