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Ny offence in connection with any motor vehicle(s) during the past 5 years or have any prosecution pending? a notifiable health condition? Please detail below, see page 2 for further information. been declined motor insurance, had any special items imposed or a motor policy cancelled? How long Resident in the UK (Yrs) Occupation (Full & Part Time) Yes Yes Yes No No No Yes had any accidents, losses or claims during the past 3 years? No If you have answered.
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