NCB Form - RightSure

No Claims Bonus Declaration Form

Title

First Name

Last Name

Address

Company

Telephone

Policy Details

Policy Number

Policy Type

Policy Inception Date

Terms Applied (if any)

Vehicle Registration

Number of Years Entitlement

Protected

Yes No

Claims, Convictions, Faults, and Non-Faults

Yes No

Skip this step if you haven't had any claims

Type

Date

Details

Allow RightSure to call the Insurer

I confirm that the information stated has been verified by telephone with the insurers who have confirmed that it is complete and accurate. In returning this facility it has been agreed that disciplinary action will be taken against any staff involved in its misuse. Random audits will be carried out. Any details omitted will invalidate this declaration.

No Claims Bonus Declaration Form

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