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Track Day Insurance
Normal motor insurance does not cover your car whilst being used on a Track Day. Specialist Track Day insurance is available which provides accidental damage cover for your car whilst being used on a track. It does NOT provide any third party or passenger liability insurance.
Please take a moment to fill out this form and one of our brokers will contact you shortly to offer you a quotation or discuss your requirements further.
Title
*
[Please select]
Mr
Mrs
Miss
Ms
First Name
*
Second/middle name
*
Surname
*
Date of birth
*
Place of birth
*
Sex
*
[Please select]
Male
Female
Company
What is your occupation
*
Are you self employed
*
[Please select]
Yes
No
What is your employers business
Name or number of your home
*
Postcode
*
Do you own or rent this property
*
[Please select]
I own it
I rent it
E-mail address
*
Daytime telephone number (including code)
*
Evening contact number (including code)
*
How did you hear about us
*
[Please select]
Existing client
Past client
Recommendation
Radio advert
Press advert
Yellow pages
Facebook
Make of vehicle
*
Model of vehicle (including L, LX etc)
*
CC of vehicle
*
Year of make
*
Modifications (please give some detail)
*
Value
*
Registration number (if known)
Who owns this car
*
[Please select]
I do
Parent
Spouse
Someone else owns it
Lease/hire company
Its a company car
What type of licence do you have
*
[Please select]
Full UK/CI/Isle of Man
Full EU
Provisional
Other
When did you pass your test dd/mm/yyyy
*
Who do you want to be insured to drive this vehicle
*
[Please select]
Just me
Me and my spouse
Me and one other driver
Me and 2 other drivers
Me and 3 other drivers
Me and 4 other drivers
Any driver with my permission
What is the age of the youngest driver who may use this vehicle
*
Has anyone who drives this vehicle made a claim in the last 5 years
*
[Please select]
Yes
No
Has anyone who drives this vehicle had a driving conviction in the last 5 years
*
[Please select]
Yes
No
Track venue
*
Name of Track Day organiser
*
Date of event
*
Previous experience of Track days (please give some detail)
*
Previous Track Day accidents (please give some detail)
*
Privacy and Data Protection
The Rossborough Group holds your details in accordance with relevant Data Protection Law in the UK, Isle of Man and Channel Islands. Some or all of the information you supply to us in connection with your insurance proposal will be held on computer and may be passed to insurance companies for underwriting and claims purposes. In addition, we may use some of the information to advise you of other products and services offered by the Rossborough Group. If you do not wish to receive such details please contact our Compliance Officer.
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Please take a moment to fill out this form and one of our brokers will contact you shortly to offer you a quotation or discuss your requirements further.
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