Step 1 of 4 About the rider Your identity, contact, address and employment information.
Personal details
Next: bike & use
Step 2 of 4 Your Avenrà and how you’ll use it Order, vehicle, usage, storage and security details.
Included benefit We use your order or allocation reference to confirm that complimentary first-year insurance was included. This form never asks for card or bank details.
Order and vehicle
Use and mileage Class of use * Select… Social, domestic and pleasure Social, domestic, pleasure and commuting Personal business use Delivery / courier use
Expected annual mileage *
Will you carry pillion passengers? * No Yes
Other motorcycles in household *
Additional riders required? * No Yes
Additional rider contact request * Only name a rider who has agreed to be contacted by Avenrà or its appointed insurance partner.
Insurance partner selection Partner preference * No preference — Avenrà to select Sterling Principal Devitt Motorcycle Direct Carole Nash Bikesure We’ll choose the partner best placed to help. A stated preference cannot be guaranteed, and eligibility and underwriting criteria still apply.
Next: licence & history
Step 3 of 4 Licence and insurance history Please answer accurately for all vehicle types, not only motorcycles.
Licence and experience
Previous and current insurance Currently insured on another motorcycle? * No Yes
Current insurer and renewal date *
Insurance refused, cancelled or voided? * No Yes
Refusal / cancellation details *
Claims, losses and motoring history Any accidents, claims, thefts or losses in the last 5 years? * No Yes
Claim / loss details *
Any motoring convictions, fixed penalties or pending prosecutions in the last 5 years? * No Yes
Current licence points *
Conviction / prosecution details *
Any drink- or drug-driving offence in the last 5 years? * No Yes
Disqualified from driving in the last 5 years? * No Yes
Disqualification details *
Other material information Medical condition or disability requiring DVLA notification or affecting riding? * No Yes
Health information relevant to riding *
Any unspent non-motoring criminal conviction? * No Yes
Unspent conviction details *
Anything else that may affect the risk
Review details
Step 4 of 4 Review and send Check the statement of fact carefully before authorising us to share the necessary information with our insurance partners.
Submitting this form does not activate insurance You must not ride until your appointed insurance partner or insurer has issued written confirmation that cover is in force, including the exact start date and time.
Your confirmations I confirm the information is true, complete and accurate. I understand that missing or incorrect information may affect a quotation, invalidate cover or cause a claim to be declined.I authorise Ampera EV Ltd trading as Avenrà to verify my eligibility and share the relevant information with one or more of its carefully selected specialist insurance partners. These may include Sterling, Principal, Devitt, Motorcycle Direct, Carole Nash and Bikesure, and their insurer panels, solely to obtain and arrange the requested cover. I have read the privacy notice .I explicitly consent to the use and disclosure of the health and offence-related declarations in this form, including where my answer is “No”. They will only be used where necessary to assess and arrange this insurance, and an insurance partner may contact me to confirm them directly.I understand this is an insurance-intake submission, not a quote, policy, certificate or cover note. Cover starts only when confirmed in writing by the appointed insurance partner or insurer.
Submission received Thanks. We have your details. Avenrà will verify the complimentary-cover benefit on your order and securely share the information with the carefully selected specialist insurance partner best suited to arrange your cover. Your partner may contact you if anything needs confirming.
Your submission reference — Keep this for your records. This reference is not a policy number.
Your bike is not insured by this confirmation. Wait for your appointed insurance partner or insurer to issue written policy documents and confirm the precise start date and time before riding.
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