Online Agreed Valuation - Step 1

                                               CUSTOMER DETAILS

Title: 
First Name:
Surname:
Postcode:
Daytime Phone Number:
E-mail Address:

                                               VEHICLE HISTORY

Purchase Price
Purchase Date
Has the vehicle been imported?

                                               VEHICLE INFORMATION

Vehicle Make:
Vehicle Model:
Registration Number:
Current Mileage Reading:
Date Of Mileage Reading:

                                               VEHICLE CONDITION

Bodywork and Floor Pan:
Paintwork and exterior trim:
Engine and its Components:
Gearbox and Drive Shafts:
Interior, Electrical Equipment/Wiring:
Suspension and Braking System:
Wheels and Tyres:
Details of major restoration work:

                                               VEHICLE MODIFICATIONS

If you have any modifications that have NOT previously been disclosed to us, please first contact our customer services department as an additional premium may be required.
Warning - Non Disclosed modifications could result in your policy being cancelled

Has the vehicle been modified from standard?
  Modified
Y/N		 Date
Modified		 Professionally Modified Y/N Total
Cost
Bodywork and Floor Pan (Chassis):
Paintwork and exterior trim:
Engine and its Components:
Gearbox and Drive Shafts:
Interior, Electrical Equipment and Wiring:
Suspension and Braking System:
Wheels and Tyres:
Details of modifications:

                                               YOUR ESTIMATED VALUE

Your estimated market value of the above described vehicle is:

PLEASE NOTE:
 if the valuation amount you require is different to the vehcile valuation you advised us on the phone please contact the office as this may result in an additional premium being required

                                               ADDITIONAL INFORMATION

Any Extra Information to support your agreed value
e.g. give details if you have a club or independant valuation, links to similar cars for sale or anything else you feel will help your requested valuation.
Our valuations are based on the current market resale value of the vehicle not the build/restoration cost.

                                               PAYMENT DETAILS

A payment of £ 11.75 is required for an Agreed Valuation to be applied to your policy. The payment will not be taken until the valuation has been received, approved and added to your policy and your insurers have been notified. This could take up to 30 days.
Card Type:
Credit Card Number:
Full Name On Card:
Valid From:
Expires End:
Issue Number
(If Applicable):
CVV Number
(last 3 digits on back of card):

 

© Copyright HIC Insurance 2007 - All rights reserved VolksWorld Insurance Services is brought to you by HIC. VolksWorld Insurance Services is a trademark of IPC Media, who acts as an introducer to us, HIC - Herts Insurance Consultants ltd - Registered No. 3735354, Registered Office, 22-26 Kings Street Kings Lynn Norfolk PE30 1HJ. HIC is incorporated in the UK and is authorised and regulated by the Financial Services Authority No 309073. We are members of the Financial Services Compensation Scheme and the Financial Ombudsman Service. HIC will arrange and administer your insurance which will be underwritten by selected insurers.