Insurance Included Offers - Request Form

Before completing this form, please ensure you have provided the customer with a one year's free insurance flyer, which includes information on key eligibility, how to activate cover and a link to view the full terms and conditions and eligibility criteria.

Important note: to enable customers to activate their cover, you must complete this form for all eligible vehicle sales.

Please note one year's insurance included offer is no longer available for Volkswagen Polos ordered after 1st July 2018.

Vehicle Details

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Retailer Details

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