Do you or any named driver suffer from any loss of or use of limb/eye/defective hearing or sight not corrected by hearing aids/spectacles or any other infirmity.
If yes give details. Yes No

Have there been any accidents, claims or losses whether to blame or not during the past 5 years in respect to any motor vehicle owned or driven by you or any named driver. Yes No If yes state for each claim date, type of claim e.g. accident/theft, amount of damaged caused to yourself and the third party if applicable and whether it was settled 100% in your favour.

Have you or any driver ever been convicted of any offence including any fixed penalty in connection with any motor vehicle or any criminal conviction.?.
Yes No If yes state for each offence conviction date and incident date, conviction code, points/fine/ban received and alcohol reading if applicable.

Have you or any driver ever been refused insurance /had a policy cancelled/ or had an increased premium imposed by your insurers.
If yes give details Yes No