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REQUEST A QUOTE - EUROPEAN AUTO FORM

This application form is for UK registered vehicles kept in the UK. If the vehicle is being brought into Europe on a temporary basis, you need to go to the following website to apply for cover Quantum Underwriting Solutions

This form has to be completed and submitted as an online application. We cannot accept handwritten or scanned forms.

For information on how we use your personal data please refer to our Privacy Notice.

Producer/Broker Details

Email address doesn't match

Clients US Business Information

Is the client a US or Canadian Citizen? (Required)

Client Information

Vehicle Details

How many vehicles do you wish to Cover? (Required)

Vehicle 1

Period Owned

More than 3 months overseas in a year (Required)

Any Modifications (Required)

More than 8 Seats (Required)

Storage Situation (Required)

Tracker Position (Required)

Vehicle 2

Period Owned

More than 3 months overseas in a year (Required)

Any Modifications (Required)

More than 8 Seats (Required)

Storage Situation (Required)

Tracker Position (Required)

Vehicle 3

Period Owned

More than 3 months overseas in a year (Required)

Any Modifications (Required)

More than 8 Seats (Required)

Storage Situation (Required)

Tracker Position (Required)

Vehicle 4

Period Owned

More than 3 months overseas in a year (Required)

Any Modifications (Required)

More than 8 Seats (Required)

Storage Situation (Required)

Tracker Position (Required)

Vehicle 5

Period Owned

More than 3 months overseas in a year (Required)

Any Modifications (Required)

More than 8 Seats (Required)

Storage Situation (Required)

Tracker Position (Required)

Driver Details - Client

Has the client had any auto accidents or claims in the last 5 years? (Required)

Has the client had any auto offences in the last 5 years? (Required)

Is the client experienced in driving the vehicle proposed for cover? (Required)

Additional Driver Details

How many additional drivers do you want to cover? (Required)

Additional Driver Details - Driver 2

Has the driver had any auto accidents or claims in the last 5 years? (Required)

Has the driver had any auto offences in the last 5 years? (Required)

Is the driver experienced in driving the vehicle proposed for cover? (Required)

Additional Driver Details - Driver 3

Has the driver had any auto accidents or claims in the last 5 years? (Required)

Has the driver had any auto offences in the last 5 years? (Required)

Is the driver experienced in driving the vehicle proposed for cover? (Required)

Additional Driver Details - Driver 4

Has the driver had any auto accidents or claims in the last 5 years? (Required)

Has the driver had any auto offences in the last 5 years? (Required)

Is the driver experienced in driving the vehicle proposed for cover? (Required)

Additional Driver Details - Driver 5

Has the driver had any auto accidents or claims in the last 5 years? (Required)

Has the driver had any auto offences in the last 5 years? (Required)

Is the driver experienced in driving the vehicle proposed for cover? (Required)

Additional Driver Details - Driver 6

Has the driver had any auto accidents or claims in the last 5 years? (Required)

Has the driver had any auto offences in the last 5 years? (Required)

Is the driver experienced in driving the vehicle proposed for cover? (Required)

Coverage Requirements

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Quantum Underwriting Solutions is a trading name of Arthur J. Gallagher Insurance Brokers Ltd. We are the data controller of any personal information you provide to us or personal information that has been provided to us by a third party. We collect and process information about you in order to arrange insurance policies and to process claims. Your information is also used for business purposes such as fraud prevention and detection and financial management. This may involve sharing your information with third parties such as insurers, reinsurers, other brokers, claims handlers, loss adjusters, credit reference agencies, service providers, professional advisors, our regulators, police and government agencies or fraud prevention agencies.

We may record telephone calls to help us monitor and improve the service we provide. For further information on how your information is used and your rights in relation to your information please see our Privacy Notice. If you are providing personal data of another individual to us, you must tell them you are providing their information to us and show them a copy of this notice.