BARRY GRAINGER LTD
Insurance Services
5 Chapman Way
Tunbridge Wells
Kent TN2 3EP
T: 0870 112 8103
F: 0870 112 8104 Admin
F: 0870 112 8105 Sales
   
  
     
 
 
 
 
 
   
 
 
 
     
   
 

We have many years experience in this industry and good relationships with our insurers to ensure we are giving you quality cover at the best possible price.

We look at every quote in detail to ensure we are giving you the best deal at terms that will suit you too. Simply complete the form below and we will get back to you within 24 hours* with your quotation (we do not quote online). However, this means that you get more attention and your quotation is looked at on an individual basis to ensure the best price is given.
(Please ensure to put your best renewal premium below.)

Your duty of disclosure
Your insurance is based upon the information provided to the insurance company and you must ensure that all such information is complete and accurate and that any facts that may influence the insurer's decision to accept and pay a valid claim are disclosed. Failure to disclose material information may invalidate your insurance and could mean that all of part of a claim may not be paid.

 
     
 
Driver Details
Proposer / Main Driver
Title Mr  
Mrs
  Miss  
MS
  Other  
Please Specify
 
Forename
 
Surname
 
Address 1
 
Address 2
 
Address 3
 
Town
 
County
 
Postcode
 
   
Type of Licence
  
Date Passed
  
Date of Birth
  
Occupation
  
Access to other Cars
   Yes No
Second Driver
Title Mr
Mrs
  Miss
MS
  Other
Please Specify
         
Forename
Surname
 
 
 
 
 
 
 
 
 

   
Type of Licence
  
Date Passed
Date of Birth
Occupation
Access to other Cars
Yes No
   
Total Number of Drivers
   
 
Vehicle Details
 
Make
  
Model
  
Year of Registration
 
Engine Capacity CC
 
Type e.g. GLX, ZETEC
 
Type of Body
 
e.g: hatchback, saloon etc.
Where Kept overnight
 
Estimated Value
 
Details of security devices fitted
 
How long owned
  
Please Give a Brief history on what experience you have had in the past with these vehicle types
  
Please List any modifications including values, if none, please state none
  
     
Accidents
Please provide the Date / Circumtances / Cost of Claim
Driver 1 :  
Have you had any accidents in the last 5 years ?
Yes No
Driver 2 :  
Have you had any accidents in the last 5 years ?
Yes No
Convictions
Please provide the Date / Offence Code / Points / Fine
Driver 1 :        
Have you had any convictions in the last 5 years ? Yes No
Driver 2 :        
Have you had any convictions in the last 5 years ? Yes No
Disabilities / Infirmities
Please provide the Details
Driver 1 :          
Do you have any disabilities / Infirmities ? Yes No  
Driver 2 :          
Do you have any disabilities / Infirmities ? Yes No  
Policy Details
 
Type of Cover
No Claims Discount (in years)
Protected no claims bonus
Type of Use
Annual Mileage
Insurance Start Date
Renewal / Best Premium