Quote Details

Please complete this application form to allow us to generate a Motor insurance quote for you. Find your address quickly by entering the postcode and clicking the search button. If you do not have a registration number we will still provide a quote for you. Just answer all the questions to allow us to identify your vehicle.

Postcode

Address

City/Town

County/Region

Country

Email Address

What Drivers are required?

Have any drivers got any unspent criminal convictions?

Yes

Have any drivers had insurance cancelled, refused or declined or terms imposed?

Yes

How do you normally pay for your insurance?

Your Details

Additional Driver 1

Additional Driver 2

Additional Driver 3

Additional Driver 4

Call us

03450 40 20 90

Monday to Friday: 9.00am - 7.00pm
Saturday: 9.00am - 4.00pm

Important Information

Vehicle Details

Vehicle Registration

If registration number is not found then select the car manually.

Please enter make and model details; if you are unable to find the exact vehicle specification or the vehicle is newly registered please contact us on 03450 40 20 90

Manufacturer

Model

Year of Manufacture

Transmission Type

Fuel Type

	Type	Doors	Body Type	Engine Capacity	Year of Production

Number of Seats

Who is the owner of the vehicle?

Who is the registered keeper of the vehicle?

First owner and keeper?

Yes

Year of Manufacture

The vehicle cannot be more than 25 years old

Value

Date of Purchase

Vehicle Usage

Annual Mileage

Overnight Location

Do you intend to fit a tracker?

Cover Details

Cover Date

Mercedes-Benz Insurance Services UK Limited, Registered in England No. 03510012. Registered office: Delaware Drive, Tongwell, Milton Keynes, England, MK15 8BA. Authorised and Regulated by the Financial Conduct Authority under firm reference 311715, you can check this on the Financial Services Register by visiting the FCA's website: www.fca.org.uk.

All motor policies are arranged and administered on behalf of Mercedes-Benz Insurance Services UK Limited by Lloyd Latchford Group Limited, Registered in England No. 05988054. Registered office: 3 Redman Court, Bell Street, Princes Risborough, Buckinghamshire, England, HP27 0AA. Business address: Cornwall House, Station Approach, Princes Risborough, Bucks, HP27 9DN. Lloyd Latchford Group Limited is authorised and regulated by the Financial Conduct Authority under firm reference 496330.
For mutual security, calls are recorded and/or monitored for training purposes. Please note, we may decline to quote in some circumstances.

I would like Mercedes-Benz Insurance to keep me informed of insurance products, services and additional benefits that may be of interest to me

I confirm that I have read and accepted the terms & conditions and data policy

All the information provided must be 100% accurate.
You must ensure that all email addresses and telephone numbers provided are correct.

PLEASE NOTE: Failure to comply with the above and maintain 100% accuracy through the whole process may invalidate any cover issued

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