Motorcycle Insurance Quote Sheet

📋 Calls are recorded for training and monitoring purposes. Please answer all questions accurately as any incorrect or incomplete information may invalidate cover or reduce your claims settlement. We will use your information to recommend cover.

Header

Branch

Date

Time

Primary Details

Title

First Name

Surname

Address

Postcode

How Long at Address

Mobile

Alternative Phone

Account Source (Please Tick All That Apply)

Existing Recommended Paid Leads Garage Referral Intermediary Referral LYL LYQ Promotion Social Media Internet Event Marketing List Affiliation Other

Vehicle Details

Bike 1

+ Bike 2

Vehicle Type

Registration No.

Make / Model / Body Type

Engine Size (cc)

Fuel

Transmission

Year of Manufacture

Date Registered

Date Purchased

Value (£)

Import

Y N

Sidecar Fitted

Y N

Seats

Passengers

Y N

Owned or Leased

Owner / Keeper

Mileage P.A.

Business Mileage P.A.

Mileage Reading

Euro / Overseas Use

Y N

How Long? (Overseas)

Where Kept

Address if Different from Home

Vehicle Security

Modifications

Vehicle Type

Registration No.

Make / Model / Body Type

Engine Size (cc)

Fuel

Transmission

Year of Manufacture

Date Registered

Date Purchased

Value (£)

Import

Y N

Sidecar Fitted

Y N

Seats

Passengers

Y N

Owned or Leased

Owner / Keeper

Mileage P.A.

Business Mileage P.A.

Mileage Reading

Euro / Overseas Use

Y N

How Long? (Overseas)

Where Kept

Address if Different from Home

Vehicle Security

Modifications

Policy Details

Date Due

Cover Type

Agreed Value

Y N

IOD/I&S/I+NAMED RIDERS

NCB Years

Protected NCB

Y N

⚠️ No claims bonus protection does not protect the overall price of your insurance policy. The price may increase following an accident even if you were not at fault.

NCB Protection info confirmed with client

Y N

Rider Details S = SDP | C = SDP&C | 1 = Class 1 | 2 = Class 2 | 3 = Class 3

Rider 1

+ Rider 2

Full Name

Date of Birth

Relationship Status

Occupation / Business

FT / PT

FT PT

Voluntary Work

Y N

Use (S / C / 1 / 2 / 3)

Goods Carried

Y N

Licence Type

Licence Held (Yrs)

CBT Date Passed

Perm. UK Resident

Y N

Years in UK

Main User

No. of Other Vehicles Owned

NCB on Other Vehicles

Named Driver Vehicles

Full Name

Date of Birth

Relationship Status

Occupation / Business

FT / PT

FT PT

Voluntary Work

Y N

Use (S / C / 1 / 2 / 3)

Goods Carried

Y N

Licence Type

Licence Held (Yrs)

CBT Date Passed

Perm. UK Resident

Y N

Years in UK

Main User

No. of Other Vehicles Owned

NCB on Other Vehicles

Named Driver Vehicles

Mileage, Occupation & Usage Align?

Y N – reconfirm with client

Homeowner

Y N

Property Type

Rider Declarations — All Riders (Add Y or N)

Previous criminal convictions?

Y N

Previous terms imposed against any policy?

Y N

Refused, cancelled or voided policies?

Y N

Illness and infirmities?

Y N

County Court Judgements, Bankruptcy or Individual Voluntary Arrangements?

Y N

Accident, claims or losses in any vehicle within last 5 years regardless of blame?

Y N

Service received during claim?

😊 😐 😞

Previous motoring convictions?

Y N

Previous fixed penalty offences?

Y N

Pending fixed penalties or convictions?

Y N

Claims

Rider No.	Date	Circumstances	Cost Inc PI (£)	This Policy	FRM

Medical Conditions

Rider No.	Condition	When Diagnosed	DVLA Aware	Licence Restricted	Reg. Disabled & Badge Holder

Convictions

Rider No.	Conviction Date	Code	Points / Ban	Fine (£)

Quote & Payment Details

Current Alt. Quote (£)

Current Alt. Insurer

Excess (£)

Annual or DD

Annual DD

What is Important to You on a Policy? (Cover / Legal / Breakdown etc.)

Data Check Consent

Some insurers perform external data checks prior to calculating a premium. These will include a credit check which will appear on your credit history whether you proceed or not. Is this OK?

Y – OK to proceed N – Not OK

Marketing Opt-In

That's everything I need to know to look at your insurance. We'd love to stay in touch with you, whether that be with ways we can try to save you money or useful information we like to share. We're likely to reach out to you by email, text, and phone — if that's ok with you?

Phone Email SMS Do Not Market

You can change this whenever you want.

✓

Vulnerabilities

For us to best support you, are there any specific needs that you have that we need to be aware of?

🧮 Specialist Quote Calculator (Ageas)

Years with Howden

Claim in Last 3 Years

Security Device

Licence Type

Trike Experience

Class of Use

Occupation

Car-derived / Self-built Trike?

Vespa-Piaggio Ape?

UK Tuk Tuk Owners Group?

Owns another everyday motorcycle?

Non-Cruiser style 1990 or over?

Turbo/Supercharged < 12 months?

Specialist Quote Price

Motorcycle on Cover — Sales Sheet

Complete this section when placing the policy on cover

Cover Details

Who Arranged

Date

Time

Cover From — Date

Cover From — Time

Confirm Reg No/s

Counter & Telephone Sales

Counter Sales Only

Client has received a certificate, schedule, IPID, personal quote letter, policy booklet and Terms of Business.

Confirmed

Telephone Sales Only

To arrange cover, I will outline the policy and send full details along with our terms of business, company details, FCA status, how to complain, charges and the compensation scheme. Is this OK? (Tick if agreed only)

Agreed

Our recommendation is based on the information you have given and is a fair analysis of our panel of insurers in the motor insurance market. (Please tick where required)

✓

Your policy is for 12 months. You can cancel the policy within 14 days and you will only be charged for the time you have been on cover. After 14 days, a £ cancellation charge applies. For policy alterations, we make a charge of £

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FAB Enhancement Discussions

Select which enhancements will be added to the policy:

⚖️

Legal Cover

£34

🔧

Breakdown Cover

£55

🛡️

Excess Protection

£38 / £47 / £56

🪖

Helmet & Leather Cover

£30 / £40

Legal Cover — £34

I'll make sure that's added for you. Just to let you know we use a single insurer for this product provided by ARAG plc (underwritten by ARAG Legal Expenses Insurance Company Limited) provides £100,000 of cover to pursue uninsured losses such as personal injury where the prospects of recovery are greater than 50%.

Breakdown Cover — £55

This product is provided by a single insurer, AXA Insurance Plc, and a breakdown that has currently occurred will not be covered under the terms of the policy.

Excess Protection — £38 / £47 / £56

I'll make sure that's added for you. Just to let you know we use a single insurer for this product provided by KGM and the policy covers all of your excesses on this vehicle with the exception of your glass excess.

Cover Level:

Helmet & Leather Cover — £30 / £40

I'll make sure that's added for you. Just to let you know we use a single insurer for this product provided by Trinity Lane and a £50 excess is applicable to each claim, a deduction may be made for wear and tear, and cover is only provided for damage to your motorcycle clothing and helmet as part of a road traffic accident.

Cover Level:

Cover Type & Excess Details

Cover Is:

Comprehensive Third Party Fire & Theft Third Party Only Accidental Damage, Fire & Theft

Please confirm the following:

Riders Use for each rider Voluntary excess Compulsory excess NCD protection included?

Cover Is Based On NCB

NCB

NCB %

Which you have decided to protect at an additional cost of £

No. of Claims

In (Years)

Years Before Bonus is Affected

Vehicle Value on Total Loss

MARKET VALUE

The policy we are arranging will pay the market value of the vehicle upon a total loss.

✓

AGREED VALUE

The policy we are arranging will pay the market value of the vehicle upon a total loss until your insurer confirms the agreed value, following receipt of a completed agreed value request form and photos.

✓

IF AGREED VALUE: Please return the agreed value request form, along with the photos described on the form, as soon as possible so that we can confirm with your insurer.

£ Proposed Agreed Value

Endorsements & Policy Conditions

Item	Advised?	Item
Exc. Riding Other Bikes?		Garage Warranty Inc?
Security Requirement?		Limited Mileage Clause?
Other Endorsement?	✓	Notes

Do you have any questions about the information provided?

Premium Breakdown Section to be completed for telephone and counter sales

Insurer

Underwriting Premium

IPT @ 12%

TOBA Fee

Insurer Fee

Total Fee

XSP Cost

LEI Cost

H&L Cost

Breakdown Cost

Total (All In) £0.00

Is the policy to be financed?

Is the client paying by debit or credit card?

We'll send your renewal when your policy's due, along with any other options that might work for you. To keep things easy, we will take the payment automatically a few days before it's due, so your cover stays in place without you needing to do anything, just let us know in advance if you don't want us to do this.

Finance

Deposit

No. of Payments

Payment Value

Cost of Finance

Total Payable (Finance)

Tick to Read

✓

You have asked to pay this by monthly direct debit using Premium Credit Limited for whom we act as a Credit Broker.

As discussed, you have agreed to pay — monthly payments of £—. The charge for this is 13.44%. The APR is 26.8%. Making the total amount payable £—. Resulting in a difference in cost of £—. Monthly difference £—.

Premium Credit Ltd will carry out a credit check. This credit check will appear on your credit record. Are you happy that the premium is affordable and that the application can proceed?

You will receive an email or letter containing full details of your credit agreement. Please read the information carefully as it will include the terms of your premium finance such as £25 fee for missed payments. It's important you read, sign and return the agreement either online or by post. Should you wish to stop your insurance automatically renewing, please contact us at any time to cancel this facility. You can do this by telephone, post or in branch. Please be aware that if you do cancel this facility your policy will expire on the renewal date, and you will no longer be covered unless you contact us to renew. If you wish to terminate the finance agreement early, please let us know and we will calculate the settlement balance from the premium finance provider for you. As we arrange payment for your policy by direct debit we collect and hold your bank details. Therefore, if you change these at any time, please contact us to arrange for these to be updated.

Do you have any questions before we proceed?

Additional Notes

Closing Statements & Confirmations

We are here to help with any aspect of your insurance policy, so if you need to ask a question, make a claim, or change your cover, please contact us first as we would be delighted to help.

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If there's anything going on in your life that means you need a bit of extra support to use our services, just let us know.

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Do you have any questions about the information provided?

✓

Thank you for taking out a policy with us. We will email your documents, we trust this is okay. Please remember to tell your friends about us and our excellent service.

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Cross Sell Opportunities

Have you discussed the Home Challenge? Try to quote now and if the client says no then create an opportunity below. Have you discussed additional policy needs (e.g. Car/Van/2nd car/spouse's car). Discuss benefits of having all policies under one roof. Try to quote now and if the client says no then create an opportunity below. Have you checked client's occupation for potential for commercial opportunities? Try to pass to a commercial advisor now and if the client says no then create an opportunity below. Have you discussed Life and Health Insurance products such as Income Protection. If the client is interested create an opportunity below.