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Individual / Joint  Application
Thank you for choosing to protect your lifestyle with ChauffeurPlan. Please complete the application form below. If you require individual cover please click here to apply. Should you require full partner cover at half the normal premium please complete the application below for principal and partner as well.

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

Enter Principal's Details
Title Principal: *
Surname Principal: *
Initials Principal: *
Address: *
County:
Postcode: *
Telephone
Email: *
Date of Birth: Day Month Year   *
Occupation:
Enter Partner's Details
Title Partner: *
Surname Partner: *
Occupation Partner:
Date of Birth Partner: Day Month Year *
Please tick to confirm that you hold and have held a current, valid, full UK driving licence for a period of at least two years*
   
Principal *
Partner *

  

 Do you have any Penalty Points, current or pending, if so how many?*
 
Principal *
Partner *

 
Discount Ref: Code Enter any relevant additional discount code here.
Plan Required Principal 4 Star 3 Star 2 Star 1 Star   
Not valid if discount Ref Code used.

£299.25

£161.50

£123.50

£85.50

 Includes 5% discount
Plan Required Partner 4 Star 3 Star 2 Star 1 Star   
Not valid if discount Ref Code used.

£149.62

£80.75

£61.75

£42.75

 Includes 50% discount
Total  Amount inclusive of discount amaount:
I hereby apply for ChauffeurPlan cover as indicated above. I am aged 21 or over, hold and have held a current valid full UK driving licence for a period of at least 2 years and am aware of the maximum points restrictions. I 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 ChauffeurPlan of the full premium or any outstanding balance thereof. I declare that the information given in this form is correct. I understand and give consent that the information I provide about myself will be passed to or used by Isle of Man Assurance Ltd and its agents and subcontractors and ChauffeurPlan 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.