Please enable JavaScript in your browser to complete this form. - Step 1 of 3Are you an existing client *Please selectYesNoTitle *First Name(s) *Surname *Address *Post Code *Telephone Number *Email *Date of Birth *Occupation *Date passed UK driving test *Alternatively, please advise how old you were when you passed your testNextTractor Make *Tractor Model *Year of Make *Current Value *RegistrationWould you like to include any additional tractors in this quote?NoYes2nd Tractor Make *2nd Tractor Model *2nd Tractor Year of Make *2nd Tractor Current Value *2nd Tractor RegistrationWould you like to include a 3rd tractor to this quote?NoYes3rd Tractor Make *3rd Tractor Model *3rd Tractor Year of Make *3rd Tractor Current Value *3rd Tractor RegistrationWould like to include any additional tractors with this quote? *NoYesPlease advise YEAR, MAKE, MODEL and VALUE for any additional tractors *Has your tractor(s) been modified? *Please SelectNoYesPlease describe any modifications *Level of Cover *Comprehensive CoverThird Party Fire and Theft CoverThird Party OnlyWill the tractor(s) be taken to shows, road runs or ploughing matches? *Please SelectYesNoWhat will the tractor be used for? *Please SelectSocial Domestic and Pleasure OnlySocial Domestic and Pleasure and Business UseWill the tractor(s) be used for your own private agricultural use? *Please SelectYesNoPlease describe what work the tractor might do *This is a key question to ensure we quote your tractor under the correct policy. If the tractor is used in connection with making hay, collecting fire wood, looking after livestock or similar, we would ask if this for your own use only or if you pass or sell any of this to others or at market. It would also be useful to know how many livestock you have if applicable.Do you earn any money or receive any payment in connection with the work the tractor does? *Please SelectYesNoIf the tractor is being used for agricultural purposes, please advise if the tractor is worked on your own land? *Please SelectYesNoHow many acres do you own? *How many acres is the tractor used on? *Do you use the tractor for agricultural purposes on anybody else's land? *Please SelectYesNoNextWill there be any drivers under the age of 21? *Please SelectYesNoFull Name *For any driver under 21Date of Birth *Occupation *Type of licence held *Please SelectFull UK Car LicenceProvisional LicenceTractor LicenceOtherNoneWhat licence do they hold? *Do you need to include any additional drivers under the age of 21? *NoYesFull name *Date of Birth *Occupation *Type of licence held? *Full UK car licenceProvisional LicenceTractor LicenceNoneOtherWhat licence to they hold? *Do you need to include any additional drivers under the age of 21 *NoYesPlease provide full details for any additional drivers under 21 *Who will be driving the tractor(s) *Please SelectInsured OnlyInsured and Named Drivers2nd Drivers Full Name *Please advise details for the 2nd driver. We do not need policyholder details againDate of Birth *Occupation *Date passed UK driving test *Alternatively, age they passed driving testWould you like to include any additional drivers *NoYes3rd Drivers Full Name *Date of Birth *Occupation *Date passed UK driving test *Alternatively, age they passed driving testWould you like to include any additional drivers *NoYesPlease provide NAME, DATE OF BIRTH, OCCUPATION and DATE PASSED DRIVING TEST for any additional drivers *Do all drivers have another vehicle for everyday use? *Please SelectYesNoHave all drivers been a UK resident since birth *Please SelectYesNoHave you or any driver incurred any convictions in the last 5 years? *Please SelectYesNoDrivers Name *Conviction Date *Offence *Conviction Code *Did the conviction result in a fine? *Please SelectYesNoFine *Did the conviction result in any points on driving licence? *Please SelectYesNoHow many points were received? *Did the conviction result in a driving ban? *Please SelectYesNoPeriod of ban *If no ban, please enter 0Are there any other convictions to declare? *NoYesPlease advise full details of any further convictions *Have you or any driver been involved in any claims or accidents in the last 3 years? (including fire, theft and non fault claims) *Please SelectYesNoWe do not need to be advised of any windscreen claims or speed awareness coursesDriver Name *Date *Description of claim *Claim cost *Were there any injuries? *Please SelectYesNoAre there any further claims or accidents to declare? *NoYesPlease give full details of any further claims or accidents *Do you or any driver suffer with any medical conditions? *Please SelectYesNoPlease advise of the drivers name, medical condition and date of onset *Have you had to notify the DVLA of any of these medical conditions? *Please SelectYesNoAre there any restrictions on your licence *Please SelectYesNoIf you have any specific questions or you are unsure of any of the answers given, please advise belowSubmit