Test & Race Day Insurance Form | Grove & Dean Motorsport Insurance

Motorsport Race / On Track Insurance Quotation Form

Personal details

Team / Individual name:

Contact name:

Email:

Contact number:

Car details

Number of cars insured:

Make and model of car(s):

Total replacement value:

Event details

Championship / Series:

Number of race events / Weekends:

Date of next test day:

Driver details

Name:

Age:

License:

Number of years racing:

Insurance cover details

Full replacement value quote required:
YesNo

If no, what sum insured is required:

Insurance cover details

Have you ever been insured before?:
YesNo

If yes, please state with whom and renewal date:

Details of accidents by drivers stated above in past 3 years:

Has any insurer declined / refused / imposed special conditions on your previous on track insurance:

YesNo

Declaration

I/we hereby declare that to the best of my/our knowledge, that the statements made in this proposal are true and complete and that I/we have not suppressed or mis-stated any material facts.

I/we agree that this application and declaration, together with any information supplied by me/us, shall form the basis of the contract between myself/ourselves and the Insurer.

I/we understand that completion of this application form does not bind myself/ourselves or the Insurers to any form of insurance contract.

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