Home
BUY NOW
What is ChauffeurPlan?
Licence Insurance Premiums
  Licence Insurance Benefits
Who are we?
FAQs
Policy Wording
Contact Us
Site Map
  Terms and Conditions
 
 
 

Company / Group Application
Thank you for choosing to protect yourselves with ChauffeurPlan. Please complete the application form below.

If you are aged 21 or over and hold and have held a current, valid full UK driving licence for a period of at least 2 years cover is guaranteed.

Here you can find more information regarding which level of cover you may require.

Fields marked with an * are mandatory and must be completed in order to progress.
Contact Title: *
Company Name: *
Contact Surname: *
Contact Initials: *
Contact Job Title: *
Address: *
County:
Postcode: *
Telephone
Email: *
First Member Details
Title: *
Initials: *
Surname: *
Date of Birth: Day Month Year   *
  Please tick  to confirm that the above named individual has held a current, valid, full UK driving licence for a period of at least two years*
Do you have any Penalty Points, current or pending, if so how many?*
Plan Required 4 Star 3 Star 2 Star 1 Star   

£269.33

£145.35

£111.15

£76.95
All Members Entered Click Here
Second Member
Title:
Initials:
Surname:
Date of Birth: Day Month Year  
  Please tick  to confirm that the above named individual has held a current, valid, full UK driving licence for a period of at least two years
Do you have any Penalty Points, current or pending, if so how many?*
Plan Required 4 Star 3 Star 2 Star 1 Star   
 £269.33  £145.35  £111.15  £76.95
All Members Entered Click Here
Third Member
Title:
Initials:
Surname:
Date of Birth: Day Month Year  
  Please tick  to confirm that the above named individual has held a current, valid, full UK driving licence for a period of at least two years
Do you have any Penalty Points, current or pending, if so how many?*
Plan Required 4 Star 3 Star 2 Star 1 Star   
 £269.33  £145.35  £111.15  £76.95
All Members Entered Click Here
Fourth Member
Title:
Initials:
Surname:
Date of Birth: Day Month Year  
  Please tick  to confirm that the above named individual has held a current, valid, full UK driving licence for a period of at least two years
Do you have any Penalty Points, current or pending, if so how many?*
Plan Required 4 Star 3 Star 2 Star 1 Star   
 £269.33  £145.35  £111.15  £76.95
All Members Entered Click Here
Fifth Member
Title:
Initials:
Surname:
Date of Birth: Day Month Year  
  Please tick  to confirm that the above named individual has held a current, valid, full UK driving licence for a period of at least two years
Do you have any Penalty Points, current or pending, if so how many?*
Plan Required 4 Star 3 Star 2 Star 1 Star   
 £269.33  £145.35  £111.15  £76.95
All Members Entered Click Here
Sixth Member
Title:
Initials:
Surname:
Date of Birth: Day Month Year  
  Please tick  to confirm that the above named individual has held a current, valid, full UK driving licence for a period of at least two years
Do you have any Penalty Points, current or pending, if so how many?*
Plan Required 4 Star 3 Star 2 Star 1 Star   
 £269.33  £145.35  £111.15  £76.95
All Members Entered Click Here
Seventh Member
Title:
Initials:
Surname:
Date of Birth: Day Month Year  
  Please tick  to confirm that the above named individual has held a current, valid, full UK driving licence for a period of at least two years
Do you have any Penalty Points, current or pending, if so how many?*
Plan Required 4 Star 3 Star 2 Star 1 Star   
 £269.33  £145.35  £111.15  £76.95
All Members Entered Click Here
Eighth Member
Title:
Initials:
Surname:
Date of Birth: Day Month Year  
  Please tick  to confirm that the above named individual has held a current, valid, full UK driving licence for a period of at least two years
Do you have any Penalty Points, current or pending, if so how many?*
Plan Required 4 Star 3 Star 2 Star 1 Star   
 £269.33  £145.35  £111.15  £76.95
All Members Entered Click Here
Ninth Member
Title:
Initials:
Surname:
Date of Birth: Day Month Year  
  Please tick  to confirm that the above named individual has held a current, valid, full UK driving licence for a period of at least two years
Do you have any Penalty Points, current or pending, if so how many?*
Plan Required 4 Star 3 Star 2 Star 1 Star   
 £269.33  £145.35  £111.15  £76.95
All Members Entered Click Here
Tenth Member
Title:
Initials:
Surname:
Date of Birth: Day Month Year  
  Please tick  to confirm that the above named individual has held a current, valid, full UK driving licence for a period of at least two years
Do you have any Penalty Points, current or pending, if so how many?*
Plan Required 4 Star 3 Star 2 Star 1 Star   
 £269.33  £145.35  £111.15  £76.95
All Members Entered Click Here
Total Group Amount:
I/we hereby apply for ChauffeurPlan cover as indicated above. I/we are aged 21 or over, hold and have held a current valid full UK driving licence for a period of at least 2 years and are aware of the maximum points restrictions. I/we agree to be bound by the cover of our choice and the rules of ChauffeurPlan from time to time in force. Payment of any claims will be made only after receipt by Isle of Man Assurance Limited of the full premium or any outstanding balance thereof. I/we declare that the information given in this form is correct. I understand and give consent that the information I provide about myself and, if applicable, my partner will be passed to or used by Isle of Man Assurance Ltd and its agents and subcontractors and for and in connection with my insurance. This includes underwriting, processing, claims handling and fraud. No claims can be accepted where the offence, injury or incident occurred prior to the start date of the policy.

† CONDITIONS: ChauffeurPlan cover applies while driving any car you are legally entitled to drive. Cover does not apply to motorcycles. Cover for Car Hire and Emergency Travel is conditional on the incident being the subject of a Motor Insurance claim and does not apply as a result of fire, mechanical fault or breakdown. ChauffeurPlan does not cover disqualification imposed as a direct result of drink or drugs related offences or reckless, dangerous, careless or inconsiderate driving. In order to be covered for “totting up" disqualification benefits you must have no more than 7 points on your licence actual, possible and/or pending when you apply . However, when the penalty points are down to 7 with no prosecutions possible or pending you will then automatically be covered against disqualification following the totting up of future penalty points. Cover is not available to taxi or minicab drivers.

I have read, understand and accept the terms and conditions of the policy. *

 

From time to time Isle of Man Assurance Ltd may write to you with details of offers that may be of interest to you. If you would like to hear from us please tick the box.