CompuQuote - Quick Quote

Agricultural

All items marked in red are mandatory

Target Premium
Date Cover Required
Broker Name
Broker Reference
Postcode
Telephone
Email
Contact

Yes No
If Yes, please complete the 'Convictions' sectiion of the form below

Yes No

Yes No

Proposer's Full Name

Proposer's Address

Proposer's/Main Driver's Date of Birth

Description of proposer's business

Contractor?

Yes

Mileage

Amount Required

Registration Mark (VIN or serial number required where no VRM is present)

Make

Model

Type

Type 1	Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2	Forestry Vehicles
Type 3	Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4	Specified Trailers, Trailed Mowers etc.

Year of Manufacture

Value

Please note that proof of an approved tracking device is required for all vehicles with a value of £40,000 or more within 21 days of policy inception

Level of cover

Registration Number
Security Device
Installer
Manufacturer

Registration Mark (VIN or serial number required where no VRM is present)

Make

Model

Type

Type 1	Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2	Forestry Vehicles
Type 3	Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4	Specified Trailers, Trailed Mowers etc.

Year of Manufacture

Value

Please note that proof of an approved tracking device is required for all vehicles with a value of £40,000 or more within 21 days of policy inception

Level of cover

Registration Number
Security Device
Installer
Manufacturer

Registration Mark (VIN or serial number required where no VRM is present)

Make

Model

Type

Type 1	Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2	Forestry Vehicles
Type 3	Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4	Specified Trailers, Trailed Mowers etc.

Year of Manufacture

Value

Please note that proof of an approved tracking device is required for all vehicles with a value of £40,000 or more within 21 days of policy inception

Level of cover

Registration Number
Security Device
Installer
Manufacturer

Registration Mark (VIN or serial number required where no VRM is present)

Make

Model

Type

Type 1	Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2	Forestry Vehicles
Type 3	Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4	Specified Trailers, Trailed Mowers etc.

Year of Manufacture

Value

Please note that proof of an approved tracking device is required for all vehicles with a value of £40,000 or more within 21 days of policy inception

Level of cover

Registration Number
Security Device
Installer
Manufacturer

Registration Mark (VIN or serial number required where no VRM is present)

Make

Model

Type

Type 1	Tractors, Rotavators, Pedestrian Controlled, others not on Table 2 or 3 Combine Harvesters, Threshing & Bailing Machines, Sugar Beet Harvesters, Potato Harvesters,Pea Cutters, Viners, Grass Dryers, Mowers
Type 2	Forestry Vehicles
Type 3	Fast Tractors such as Mercedes Unimog, JCB Fastrac, etc
Type 4	Specified Trailers, Trailed Mowers etc.

Year of Manufacture

Value

Please note that proof of an approved tracking device is required for all vehicles with a value of £40,000 or more within 21 days of policy inception

Level of cover

Registration Number
Security Device
Installer
Manufacturer

Driver Name
Date
Claim Type
Claim Status
Cost Incurred

Driver Name
Date
Claim Type
Claim Status
Cost Incurred

Driver Name
Date
Claim Type
Claim Status
Cost Incurred

Driver Name
Date
Claim Type
Claim Status
Cost Incurred

Driver Name
Date
Claim Type
Claim Status
Cost Incurred

Driver Name
Conviction Date
Conviction
Fine
Length of ban

Driver Name
Conviction Date
Conviction
Fine
Length of ban

Driver Name
Conviction Date
Conviction
Fine
Length of ban

Driver Name
Conviction Date
Conviction
Fine
Length of ban

Driver Name
Conviction Date
Conviction
Fine
Length of ban

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CompuQuote is a trading name of Bollington Underwriting Ltd | Unit 26, Hampstead Avenue, Mildenhall, Suffolk IP28 7AS