Delivery Van Insurance Application Form
Owner's Full Name
Owner's Address
Phone Number
Email Address
Van Make
Van Model
Year of Manufacture
Registration Number
Primary Use of the Van
Goods Delivery
Courier Service
Other
Estimated Annual Mileage
Where is van kept overnight?
Number of Drivers
Driver(s) Details (Name, Age, License Number)
Previous Insurance Claims (if any)
Type of Cover Required
Comprehensive
Third Party Only
Third Party, Fire and Theft
Additional Information