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Quote {dealId}
{typeA197} Motor Insurance
User
Deal ID
CC Email
example@example.com
How is your car used?*
Is the vehicle being rented out to anyone?*
Is the vehicle being used for food delivery? (i.e UberEats)*
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(c) National Cover Pty Ltd 2024
ABN 74 639 621 480 | Corporate Authorised Representative of Shanebridge Pty Ltd
ABN 16 011 049 899, AFSL 245566

PO Box 22 Coopers Plains QLD 4108

insurance@nationalcover.com.au | Privacy Policy | General Advice Warning

Contact Details
Customer Type*
ABN
Company Name
How long have you held your ABN?*
Your Name*

First NameLast Name
Your Gender*
D.O.B*

DayMonthYear
Contact No*
E-mail*
example@example.com
Your Address*
Domain Alias
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(c) National Cover Pty Ltd 2024
ABN 74 639 621 480 | Corporate Authorised Representative of Shanebridge Pty Ltd
ABN 16 011 049 899, AFSL 245566

PO Box 22 Coopers Plains QLD 4108

insurance@nationalcover.com.au | Privacy Policy | General Advice Warning

Driving History
Will any driver operate the Vehicle(s) holding ONLY an International Driver’s Licence? (e.g. without a valid Australian Driver’s License)*
Does the vehicle's owner drive their car?*
How many years has the driver held an International Driver's License?
Age received Australian driver's licence (or equivilant)?
Have all of the drivers of the Vehicles held their Australian Driver’s Licence for a minimum of two (2) years?
Main driver's current licence type?
Have any drivers incurred any demerit points in the last three years?
Have you made any car insurance claims in the last 5 years?*
List claim/s*
Car insurance claims the main driver has made in the last 5 years?
If more than 10 claims, please write the number of claims made in the last 5 years?
In the last 5 years, have any of the drivers to be listed on this policy been declared bankrupt or had a default judgement registered against them (whether voluntary or not) for any outstanding debts?*
Have any of the drivers to be listed on this policy had their driver's licence suspended or cancelled in the last 3 years (this does not include suspensions relating to parking tickets)?*
Have any of the the drivers to be listed on this policy been convicted for drink, drug or other criminal offences in the last 5 years?*
In the last 3 years, have you or anyone to be insured under this policy had an insurance policy declined or cancelled, a renewal declined, special terms imposed, or had a claim refused?*
Have any of the drivers to be listed on this policy had a claim denied for fraud or dishonesty?*
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(c) National Cover Pty Ltd 2024
ABN 74 639 621 480 | Corporate Authorised Representative of Shanebridge Pty Ltd
ABN 16 011 049 899, AFSL 245566

PO Box 22 Coopers Plains QLD 4108

insurance@nationalcover.com.au | Privacy Policy | General Advice Warning

About Your Car
Vehicle Registration*
Vehicle Make*
Vehicle Model*
Vehicle Year*
State of Registration*
Is your vehicle registered with an 'H' plate (e.g., HC1234) and used as a limousine or chauffeur vehicle?*
Add More Vehicles?*
Additional Vehicles
Exclude drivers under 25?*
Is the car ever used for ridesharing, peer-to-peer car sharing or delivery?*
Have you purchased your car in the last 12 months and are you the first registered owner?*
Has this car been continuously insured with either third party property damage or comprehensive car insurance for the last 30 days?*
Is the car currently financed?*
If Car is Financed? Please mention Name of the Finance Company
Does the car have any modifications?*
If Modified, Please specify the modification in detail
Approximate kilometres driven each year?*
How many days a week on average is the car used for trips to work or study?*
Is the car/ vehicle currently undamaged, roadworthy and registered?*
Is the car driven three or more weekdays, on average, between the following peak times? (7:30am-9:30am and/or 3pm-6:30pm) (Peak times are applicable to both metro and regional areas.)*
How is the car normally parked at night?*
The address the car is normally kept at night?
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(c) National Cover Pty Ltd 2024
ABN 74 639 621 480 | Corporate Authorised Representative of Shanebridge Pty Ltd
ABN 16 011 049 899, AFSL 245566

PO Box 22 Coopers Plains QLD 4108

insurance@nationalcover.com.au | Privacy Policy | General Advice Warning

Cover Options

Compare Insurance Options

	Less Expensive	More Expensive
Excess	High	Low
Extras	None	Included

To reduce your premium, choose a high excess and remove extras. Lower excess and added benefits increase the cost of insurance.

What level of coverage do you need?*
What level of level of excess do you need?*
Do you require Roadside Assistance?*
Tick any policy extras you need (optional)
How to choose
For best coverage, choose Comprehensive / Low Excess / With Extras. For lowest price, choose Third Party / High excess / Without Extras.
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(c) National Cover Pty Ltd 2024
ABN 74 639 621 480 | Corporate Authorised Representative of Shanebridge Pty Ltd
ABN 16 011 049 899, AFSL 245566

PO Box 22 Coopers Plains QLD 4108

insurance@nationalcover.com.au | Privacy Policy | General Advice Warning

Price Guarantee
Why We Ask for Your Current Price

By knowing who you’re insured with and what you currently pay, we can benchmark your quote, identify savings, and offer a more competitive price based on real comparisons.
Has your car previously been insured?*
If yes, which insurer?
Which insurer?
How much is your premium ($)?
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(c) National Cover Pty Ltd 2024
ABN 74 639 621 480 | Corporate Authorised Representative of Shanebridge Pty Ltd
ABN 16 011 049 899, AFSL 245566

PO Box 22 Coopers Plains QLD 4108

insurance@nationalcover.com.au | Privacy Policy | General Advice Warning

Broker Appointment
Why We Require a Signed Broker Appointment

We need a signed broker appointment so we can contact insurers directly and request competing quotes on your behalf. This allows us to negotiate better pricing and cover tailored to your needs. Your information is kept completely secure and is never shared with third-party service providers.
Signature
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(c) National Cover Pty Ltd 2024
ABN 74 639 621 480 | Corporate Authorised Representative of Shanebridge Pty Ltd
ABN 16 011 049 899, AFSL 245566

PO Box 22 Coopers Plains QLD 4108

insurance@nationalcover.com.au | Privacy Policy | General Advice Warning
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Save Big on Car Insurance

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Contact Details

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Driving History

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About Your Car

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Cover Options

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Price Guarantee

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Broker Appointment

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