Find out more about our top quality insurance service by clicking through to our Home page. We look forward to giving you a competitive insurance quote whatever your driving convictions. Jewell Insurance covers many driving conviction codes and endeavours to offer insurance whatever your driving offence. Please see our driving convictions page to see a list of the conviction codes that we cover. Please fill in the form below. A member of staff will contact you as soon as possible to discuss your quotation. Personal Details * Denotes required fields * Inception Date: * Full Name: * Post Code: * House Number/Name:   First line of address: * Daytime Tel No: * Occupation: Industry e.g. car sales * Email Address: * Date of birth: Marital Status Married Single Any Disabilities: Yes No Your Car: *Make of Vehicle, e.g. Ford : *Model of Vehicle, e.g. Escort Ghia, LX : Value of Vehicle: Engine Size: Manual/Automatic Manual Automatic Year: Registration Number: Modified: Yes No If yes detail: Imported: Yes No Number of Doors: 2 Door 3 Door 4 Door 5 Door Other Fuel Type: Petrol Diesel Other *Alarm: Yes No *Immobiliser: Yes No Annual Mileage: *Licence Type: Full Provisional Insurance Requirements: *Type of Cover: Third Party Only Third Party, Fire and Theft Fully Comprehensive *Use: Social, Domestic and Pleasure Social, Domestic, Pleasure and Commuting Business If Business Use - Mileage *Number of years NCB Under a year 1yr 2yrs 3yrs 4yrs 5years 6years 7years 8years 9years *Lowest Premium Quoted: Driving History: Licence Type: Provisional Full *What year did you pass your test (date approximately): *Any Previous Claims? Yes No If Yes, advise date of Incident, whether fault or non fault and brief details: Driving Convictions History: Date 1: Code * Fine (£) Points Length of Ban If DR10 breath reading If DR10 blood reading Date 2: Code Fine (£) Points Length of Ban If DR10 breath reading If DR10 blood reading Date 3: Code Fine (£) Points Length of Ban If DR10 breath reading If DR10 blood reading