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TRACK DAY INSURANCE APPLICATION
What your Policy covers

What your Policy does not cover

Policy wording
Driver Details
Title:
Forename:
Surname:
Date of Birth: Please enter DD/MM/YYYY
Occupation:
Contact Details
Address:
Postcode:
Tel:     Mobile:
Email:
Track Day Details
Do you require cover for a single date or multiple dates?
If 'multiple' days, please state minimum 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 2004 shown on your certificate.
Name of Organiser(s):
Track Name(s):
Vehicle Information
Make:
Exact Model:
Year of Manufacture:
Is the vehicle road registered or purpose built track day car?
Road registration:
If 'None' state 'None'
How long have you owned this vehicle? (eg - 1 year, 2 months)
If you are not the owner of the car, please state who legally owns vehicle:
Current market value of your vehicle: £
Amount vehicle to be insured for: £

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

Additional Drivers
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
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. (click here for further details on material information)

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

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I/we confirm that I/we have read and understood the above