Step 1 of 4 - Personal information 25% Hi, let's get some details for your vehicle quote. Contact Name* First Last Email* Phone No* Name of Registered Owner* Vehicle Year/Make/Model* Registration Number* Do you have any Accessories?* Yes No Please ListDescriptionValue Any Modification?* Yes No Please ListDescriptionValue Type of Cover Requested* Comprehensive (Unlimited kms) Comprehensive ‘Limited Kilometres’ (up to 8,000km annually) Third Party Property Damage Only Sum Insured Type* Market Value Agreed Value For how much?*Does the insured wish to include any of the following cover options?Hire Car During Repairs Yes No Windscreen Excess Waiver Yes No Choice of Repairer Yes No Tell us more details about your vehicle.Use of Vehicle* Private Business Occupation* Finance* Yes No Name of Financier* Financier* Address where vehicle is left overnight* Street Address City State Postcode Parked overnight in* Garage Carport Driveway Other If Other* Security Device Fitted?* Yes No If yes, details of immobiliser or tracking system* Drivers Details*First NameLast Name% of UseDate of Birth (dd/mm/yyy) Please ensure % of Use totals to 100% across all drivers.In the LAST THREE (3) YEARS have any of the drivers had any accidents, vehicles stolen or burnt, or any other losses involving a vehicle where an insurance claim has been made?* Yes No Please provide details*Driver NameDescription of LossDate of LossCost of Loss In the LAST THREE (3) YEARS have any of the drivers committed any traffic offences which have resulted in a conviction or for which a penalty has been imposed or points lost?* Yes No Please provide details:*Driver NameDescription of OffenceDatePenalty ImposedIf Speeding, kms over limit Are you currently insured?* Yes No Please ListName of insurerExpiry DateCurrent ExcessDoes the vehicle have existing damage or hail damage?* Yes No Have you been declined insurance in the past 3 years?* Yes No Is the vehicle unregistered or does it have any existing damage (excluding minor scratches, wear and tear); or used for*- driver education; - racing or sporting events; - courier or delivery services; or Yes No used*- as a hire car, courtesy car, taxi, or to carry passengers for hire, fare or reward (direct or indirect); - as a removalist vehicle; - as a fleet/pool vehicle; or - airside? Yes No Thanks for your details, please confirm you are not a robot and we'll get onto your quote request straight away. We'll make contacts directly to you via email. CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
