ROCS Group – One Group

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Passport number
ID card number
Name
Surname

House Number/Name
Street
Town
Post Code
Telephone Number
Mobile Number
Workplace Telephone Number

Email address
Vehicle Details
Registration Number
Vehicle Make
Vehicle Model
Year of Manufacture
Engine Capacity
Estimate of present value
Driver Age
Who will be driving the vehicle?


If any one will be driving the vehicle beside yourself, please state name and age of driver
Name
Age
NB: Private Comprehensive Policies having drivers over the age of 25 years may benefit from a 10% or 7.5% premium discount should drivers be restricted to “Policyholder only” or the “Policyholder and another named driver over the age of 25 years” respectively.
Are you entitled to a no claim bonus? If yes, please state amount
Do you have other vehicle(s) insured through ROCS Co. Ltd?
Yes	No
If yes, please enter the registration number(s)
Type of cover required

Additional notes/comments

	Development House, St. Anne Street, Floriana. FRN9010	ROCS House, 19-23,Main Street, Mellieha MLH2310
	T: +356 2152 4123 F: +356 2152 3869 E: insurance@rocsgrp.com

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