Cover Required

MOTOR INSURANCE PROPOSAL FORM 01

COVER REQUIRED

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Cover Required

Comprehensive
Laid up
Third Party Fire & Theft
Third Party Only
Act

Do you wish to insure any of the following?

	Passenger Liability
	Increased Windscreen/Glass
	Hurricane, Earthquake and Flood
	Increased Third Party Limits
	Increased Manslaughter Defence costs
	Riot/Civil Commotion
	Increased Wrecker Fees
	Other

If Other

Will you require cover for towing (boat, trailer etc.)?

Yes No

Do you require

Standard cover for drivers
Restricted cover to the named drivers

Do you wish to bear an increased/reduced excess/deductible?

Yes No

Do you wish to remove any policy restrictions - age/licence

Yes No

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