MOtorSport Race&Rally Insurance Services - Another innovative brand of Everitt Boles

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Moris - motorsport insurance for the enthusiast

Car Trackday Application

CARS ONLY

Bikes Click Here

Summary of Cover • FAQ's • Policy Wording

CARS ONLY

Bikes Click Here

Existing User?

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Your Details - New User

Title:

Forename:

Surname:

Address Line 1:

Address Line 2:

Town:

County:

Postcode:

Date of Birth [dd/mm/yy]:

Occupation:

Telephone:

Fax:

Mobile:

How did you find us:

Email:

Note: Check email address. If incorrect our formal quotation will not reach you since this is only sent by email

Password:

Track Day Details
Do you require cover for a single date or multiple dates?
If 'multiple' dates, please state number of dates to be insured:
Date of track day, or date of first track day if 'multiple' dates insured:	click on calendar to choose date
Expiry Date:	If you have chosen 'Multiple' dates, there will be a natural expiry date of 15th November 2008 shown on your certificate.
Name of Organiser(s):
Name of track, or all tracks and dates if multiple days required:

Car Details
Make of Car:
Exact Model:
Year of Manufacture:
Is the car road registered or purpose built track day car?
Road registration:	If none, Tick/Click here
How long have you owned this car?	(eg - 1 year, 2 months)
If you are not the owner of the car, please state who legally owns vehicle and your relationship to them:
Current market value of your car:	£ no commas or spaces
Amount car to be insured for (cannot be more than the market value):	£ no commas or spaces

Incidents and Experiences
Approximately how many Track Days have you been on before?
Please give details of track days that you have been on, including any previous MORIS trackday insurance policy references:	If none, Tick/Click here
Details of any accidents whilst taking part in a Track Day:	If none, Tick/Click here
Details of any claims and convictions on the road within the last 5 years:	If none, Tick/Click here
Do you hold a racing licence?	Yes No
Are you currently competing in a championship?	Yes No
If 'Yes', please specify:

Additional Drivers
WARNING: Additional drivers are a nightmare! Most claims are caused by 'Additional Drivers' and none of the accidents are small! Excesses and premiums carry considerable loading.
Do you require cover for any additional drivers?	Yes No
If Yes, please state name(s):	1. 2.
Please state ages, trackday experience and details of any accidents:

Additional Material Information
Details of any other material information about the track day(s), car(s) or driver(s):

Declaration

Material Facts and Non Disclosure
I/we hereby declare that to the best of my/our knowledge, that the statements made in this proposal are true and complete and that I/we have not suppressed or mis-stated any material facts. (Further Details)

Policy Wording
It is important that you read the policy wording before you effect cover with ourselves. (Policy Wording)

Application
I/we agree that this application and declaration, together with any information supplied by me/us, shall form the basis of the contract between myself/ourselves and the Insurer.
I/we understand that completion of this application form does not bind myself/ourselves or the Insurer to any form of insurance contract.

Privacy and Security

Important: I/we confirm that I/we have read and understood the above. Further I/we confirm we have checked the accuracy of all information supplied above.