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Thank you for your interest in the BSM Marmalade Learner Insurance underwritten by Zenith Marque Insurance Services Limited.

This application is for the learner driver and must be filled in by the learner driver.

Before you start, you should read our Initial Disclosure Document that gives important information about BSM Marmalade Learner Insurance and the services offered by Provisional Marmalade.

Please confirm that you have read our Initial Disclosure Document 

Have you been involved in any accident, claim or loss (including loss by fire, theft or malicious acts), irrespective of blame during the past three years?
Have you been charged or convicted of any motoring or criminal offence (unspent under the rehabilitation of offenders act 1974) within the last 5 years, or is any such prosecution pending?
Are you a professional or semi-professional sports person or musician?
Do you suffer from a medical condition which should be notified to the DVLA (DVA in Northern Ireland) and/or have a restricted driving licence?
Have you informed DVLA or DVANI and been granted an unrestricted driving licence?
Please contact us on 0333 358 3441 for assistance or enter the medical code provided
Has the car been changed in any way from the manufacturer's original specification?

Please also read through the following information to confirm that you qualify for the policy:
The policy is only suitable for provisional drivers who wish to insure a vehicle in which they intend to practice.
The policy only provides cover when you are supervised by a qualified driver, aged 25 or over, who has held a full UK driving licence for more than 3 years.
The policy is not suitable as the main insurance for a vehicle owned by yourself. It is designed as a secondary insurance whilst you are driving a car owned by someone else. The vehicle must remain insured by the main owner at all times.
Policies are sold on the assumption that the vehicle is already separately insured. This will be checked on the Motor Insurance Database after you apply. If no match is found for the vehicle, the BSM Marmalade Learner Insurance policy will be cancelled from the start date, and you will be notified by email.
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© 2018 Marmalade All Rights Reserved. Marmalade is a trading style of Young Marmalade Limited (registered in England under company number 04627884) and Provisional Marmalade Limited (Registered in England under company number 06779950). Registered office for both companies is Marmalade House, Alpha Business Centre, Mallard Road, Bretton, Peterborough, PE3 8AF. Young Marmalade Limited is an Appointed Representative of Provisional Marmalade Limited, which is authorised and regulated by the Financial Conduct Authority under Firm Reference Number 542063. You can check this on the Financial Services Register by visiting fca.org

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