DNA Insurance
Mid Term Adjustment – Vehicle

Leading Motor Insurance Broker in UK

Is this a Change/Additional/Removal of Vehicle ? (Please Specify)
Change VehicleAdd VehicleRemove Vehicle

Policy Holder Name

Policy Reference Number

Vehicle Make

Vehicle Model

Vehicle Type
CarVanMinibus

Vehicle Registration Number

Year of Manufacturer

Number of Seats

Vehicle Value

Transmission
ManualAutomatic

Fuel Type
PetrolDieselLPGElectric

Right Hand Drive/Left Hand Drive
Left Hand DriveRight Hand Drive

Import Y/N (if yes please specify Country)
YesNo

Vehicle Modifications Y/N (if yes please specify)
YesNo

Registered Owner

Registered Keeper

Purchase Date

Security Fitted
ImmobiliserAlarmTracker

Cover Start time and date if permanent

Cover finish time and date if temporary

If a Motor Trade Please Specify if Own or Stock Vehicle