Step 1 of 4

About the rider

Your identity, contact, address and employment information.

Personal details

Title *

First name *

Last name *

Date of birth *

You must meet the legal minimum age for the selected model.

Marital status *

UK resident from birth? *

Contact details

Email address *

Mobile number *

Home address

Address line 1 *

Address line 2

Town or city *

County

Postcode *

Property type *

Occupancy *

Employment

Employment status *

Main occupation *

Employer / business type *

Second occupation

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

Order / allocation reference *

Model *

Year of manufacture *

Vehicle value (£) *

Order / purchase date *

Expected delivery date

Requested cover start date

Leave blank if delivery or registration is not yet confirmed.

Registration (if known)

VIN / chassis number (if known)

Registered owner and keeper *

Factory options or modifications

Use and mileage

Class of use *

Expected annual mileage *

Will you carry pillion passengers? *

Other motorcycles in household

Additional riders required? *

Overnight storage and security

Kept at your home address overnight? *

Overnight location *

Security fitted or always used

Avenrà Sentinel
GPS tracking / connected securityFactory immobiliser
Electronic immobilisationApproved alarm / tracker
Enter model belowGround anchor & chain
Used whenever stored at homeDisc lock
Portable physical securityNone
No additional security device

Security make / model or further details

Broker routing

Broker preference *

A preference is not a guarantee; eligibility and underwriting criteria still apply.

Step 3 of 4

Licence and insurance history

Please answer accurately for all vehicle types, not only motorcycles.

Licence and experience

Licence type *

Licence issuing country *

Licence / entitlement obtained *

Driving licence number

Some brokers may confirm this directly with you instead.

CBT expiry date (if applicable)

Motorcycle no-claims bonus *

Proof of NCB available? *

Years riding motorcycles *

Previous and current insurance

Currently insured on another motorcycle? *

Insurance refused, cancelled or voided? *

Claims, losses and motoring history

Any accidents, claims, thefts or losses in the last 5 years? *

Any motoring convictions, fixed penalties or pending prosecutions in the last 5 years? *

Current licence points *

Any drink- or drug-driving offence in the last 5 years? *

Disqualified from driving in the last 5 years? *

Other material information

Medical condition or disability requiring DVLA notification or affecting riding? *

Any unspent non-motoring criminal conviction? *

Anything else that may affect the risk

Step 4 of 4

Review and send

Check the statement of fact carefully before authorising us to approach a broker.

Submitting this form does not activate insurance

You must not ride until the appointed broker or insurer has issued written confirmation that cover is in force, including the exact start date and time.

Your confirmations

Submission received

Thanks. We have your details.

Avenrà will verify the complimentary-cover benefit on your order and route the information to an appropriate specialist broker. They 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 the broker or insurer to issue written policy documents and confirm the precise start date and time before riding.

Return to Avenrà

Your first year.
Covered.

One form. We handle the rest.

1. Provide the facts

2. We verify eligibility

3. A broker completes cover

Arrange Your Cover