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Thank you for your interest in Learner Driver Insurance from Geoffrey Insurance Services.

This application is for the learner driver and must be filled in by the learner driver.

Before you start, you should read the Terms of Business that gives important information about Learner Driver Insurance offered by Provisional Marmalade

Please confirm that you have read the Terms of Business:

Have you been involved in any accident, claim or loss (including loss by fire, theft or malicious acts), irrespective of blame during the past three years?	... No Yes
Have you been charged or convicted of any motoring or criminal offence (unspent under the rehabilitation of offenders act 1974) within the last 5 years, or is any such prosecution pending?	... No Yes
Are you a professional or semi-professional sports person or musician?	... No Yes
Has the car been changed in any way from the manufacturer's original specification?	... No Yes
Has the car been changed for disability purposes?	... No Yes

Please also read through the following information to confirm that you qualify for the policy:
	The policy is only suitable for provisional drivers who wish to insure a vehicle in which they intend to practice.
	The policy only provides cover when you are supervised by a qualified driver, aged 25 or over, who has held a full UK driving licence for more than 3 years.
	The policy is not suitable as the main insurance for a vehicle owned by yourself. It is designed as a secondary insurance whilst you are driving a car owned by someone else. The vehicle must remain insured by the main owner at all times.
	Policies are sold on the assumption that the vehicle is already separately insured. This will be checked on the Motor Insurance Database after you apply. If no match is found for the vehicle, the Geoffrey Insurance Services policy will be cancelled from the start date, and you will be notified by email.