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What do you use your Vehicle for?
Carriage of Own Goods
Carriage of Goods for Hire or Reward
Haulage
Social Only
Is this a Company Vehicle?
No
Yes
Security Features
Manufacturer fitted Alarm and/or immobiliser
Thatcham category 1
Thatcham category 2
Tracker system or similar
Other alarm or immobiliser
No Security Device
Night time parking
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Total Annual Mileage
Up to 1000
Up to 2000
Up to 3000
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Up to 6000
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Up to 10000
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Up to 42000
Up to 43000
Up to 44000
Up to 45000
Up to 46000
Up to 47000
Up to 48000
Up to 49000
Up to 50000
More than 50000
Is the specified Vehicle currently impounded by the Police?
No
Yes
Gross Weight of Vehicle
0 - 1.5 tonnes
1.6 - 2.0 tonnes
2.1 - 2.5 tonnes
2.6 - 3.0 tonnes
3.1 - 3.5 tonnes
Over 3.5 tonnes
Will the Vehicle carry hazardous goods?
No
Yes
Has the Vehicle been modified in any way from that of the manufacturer's standard specification?
No
Yes
Has the Vehicle been Imported?
No
Yes
Number of Seats
1
2
3
4
5
6
7
8
9+
Has the Vehicle been fitted with a refrigeration unit?
No
Yes
Has the Vehicle been fitted with a tipping unit?
No
Yes
Has the Vehicle been fitted with Internal Racking?
No
Yes
Vehicle Modifications
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Make and Model
Fuel Type
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Engine Size
N/A
up to 1.0
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
2.0
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
3.0 or more
Year of Manufacture (yyyy)
Transmission
N/A
Manual
Automatic
Other
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Vehicle Modifications
Paintwork / Stickers
Badges indicating increased performance
Decals/stickers
Exterior decorative changes
Magnetic/Removable Signs
Murals
Non-standard paintwork
Non-standard respray
Respray (different colour)
Side stripes
Wheels / Tyres
Wheel Arches (non standard)
Wheel spacers
Wheels - Alloy
Wheels - Carbon
Wheels - Magnesium
Wheels - Wire
Wider Tyres
Wider Wheels
Flared Wings
Accessories
Air conditioning
Car phone
Dashboard changes
Driving lights
Dual Controls
Emergency Services Blue Light
Fog Lights
High level/Extra brake lights
Interior changes
Locking Wheel Nuts
Parking sensors
Pedal Configuration (altered)
Rally/Spot Lights
Removal/Replacement of seats
Roll Cage/Roll Bars
Roof Rack
Satellite navigation system
Sports steering wheel
Sunroof
Tow Bar
Upholstery
Larger speakers
Refrigeration unit fitted
Side racks
Body modifications / Bodykit / Spoilers
Additional Windows
Body coloured bumpers
Bodykit (non standard)
Bodykit (optional extra)
Bonnet Bulge
Bonnet Bulge grill
Carbon fibre bonnet
Complete Bodykit
Fibre glass panels
Modification due to disability
Rear roof spoiler
Rear spoiler/Aerofoil
Rear Valance
Side skirts/sills
Spoiler/Airdam - Front
Strenghtening brackets
Wheelchair modifications
Windows - Front Darkened >30%
Windows - Rear Darkened >30%
Wings (non standard)
Tail lift
Water tank fitted
Windows - Tinted <30%
Bull Bars
Tinted Windows > 30%
Brakes / Suspension / Steering
Braided brake hoses
Brakes - uprated
Hand controls
Suspension lowered (<5cm)
Suspension lowered (5-12.5cm)
Suspension other (not lowered)
Engine / Transmission
Aftermarket Exhaust System - Approved for road use
Air Filter
Blueprinting
Engine - bored out
Engine - non standard
Engine - other alterations
Engine - standard replacement
Engine chip 00-10% inc BHP
Engine Chip 11-25% inc BHP
Engine chip 26%+ inc BHP
Exhaust/Manifold - Non Standard
Filters (non standard)
Gearing change
Liquid Petroleum Gas
Nitrous Oxide Kit
Supercharging
Transmission changes
Turbocharging
Petrol to diesel engine replacement - Professionally installed
Radiator bars
Other
Other
×
Vehicle Modifications
Paintwork / Stickers
Badges indicating increased performance
Decals/stickers
Exterior decorative changes
Magnetic/Removable Signs
Murals
Non-standard paintwork
Non-standard respray
Respray (different colour)
Side stripes
Wheels / Tyres
Flared Wings
Wheel Arches (non standard)
Wheel spacers
Wheels - Alloy
Wheels - Carbon
Wheels - Magnesium
Wheels - Wire
Wider Tyres
Wider Wheels
Accessories
Air conditioning
Car phone
Dashboard changes
Driving lights
Dual Controls
Emergency Services Blue Light
Fog Lights
High level/Extra brake lights
Interior changes
Larger speakers
Locking Wheel Nuts
Parking sensors
Pedal Configuration (altered)
Rally/Spot Lights
Refrigeration unit fitted
Removal/Replacement of seats
Roll Cage/Roll Bars
Roof Rack
Satellite navigation system
Side racks
Sports steering wheel
Sunroof
Tow Bar
Upholstery
Body modifications / Bodykit / Spoilers
Additional Windows
Body coloured bumpers
Bodykit (non standard)
Bodykit (optional extra)
Bonnet Bulge
Bonnet Bulge grill
Bull Bars
Carbon fibre bonnet
Complete Bodykit
Fibre glass panels
Modification due to disability
Rear roof spoiler
Rear spoiler/Aerofoil
Rear Valance
Side skirts/sills
Spoiler/Airdam - Front
Strenghtening brackets
Tail lift
Tinted Windows > 30%
Water tank fitted
Wheelchair modifications
Windows - Front Darkened >30%
Windows - Rear Darkened >30%
Windows - Tinted <30%
Wings (non standard)
Brakes / Suspension / Steering
Braided brake hoses
Brakes - uprated
Hand controls
Suspension lowered (<5cm)
Suspension lowered (5-12.5cm)
Suspension other (not lowered)
Engine / Transmission
Aftermarket Exhaust System - Approved for road use
Air Filter
Blueprinting
Engine - bored out
Engine - non standard
Engine - other alterations
Engine - standard replacement
Engine chip 00-10% inc BHP
Engine Chip 11-25% inc BHP
Engine chip 26%+ inc BHP
Exhaust/Manifold - Non Standard
Filters (non standard)
Gearing change
Liquid Petroleum Gas
Nitrous Oxide Kit
Petrol to diesel engine replacement - Professionally installed
Radiator bars
Supercharging
Transmission changes
Turbocharging
Other
Other
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