Commercial Motor Insurance Quote

COMMERCIAL MOTOR INSURANCE QUOTE

We'll arrange insurance designed to protect your commercial vehicle and passengers. Vehicles covered can include cars, utes, vans, trucks, trailers and buses. We can customise a policy to any of the following types of cover: Comprehensive, Third Party Property Damage Only, or Third Party Fire and Theft.
YOUR CONTACT DETAILS
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postcode
Phone*
Please enter a valid phone number.
Email*
Do you authorise us to send all documentation via email?

YesNo
Date cover required to start*

DayMonthYear
I would you like to direct this request to a particular OVIB broker
Broker's name
How did you hear about us?
POLICY DETAILS
Insured name*
Business activities*
ABN
Are you registered for GST?
What is your input tax credit?
Anticipated annual turnover
Total number of employees*
Include directors, full-time and part-time staff
Do you wish to note any interested party/s
DUTY OF DISCLOSURE
Claims*
Have you had any insurance claims in the past 5 years?
If yes, please provide: date of loss, what happened, total payout
Criminal convictions*
Have you ever been charged with a criminal conviction?
If yes, please provide: date of conviction, type of conviction,
Insurance declined*
Have you ever had any insurance refused,declined, or any special terms imposed?
If yes, please provide: date, type of declinature or special conditions
Bankruptcy / insolvency*
Have you ever been declared bankrupt or been involved n a company or business which became insolvent or subject to any form of insolvency or voluntary administration (e.g. liquidation or receivership)?
If yes, please provide: date

Commercial Motor Section

Covers your motor vehicles and trailers used in your business either comprehensively or for just third party property damage
Is the vehicle:*

unregistered or does it have any existing damage (excluding minor scratches, wear and tear); orused for: driver education; racing or sporting events; courier or delivery services; orused: 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?None of the above
Please provide more details
VEHICLE DETAILS
Overnight parking address*

Street Address

Street Address Line 2

CityPostcode

Postal / Zip Code
How is your vehicle/s kept overnight?*
Vehicle and cover details*
Please list all extra non-standard accessories &/or modifications to be insured
DRIVER DETAILS

Please list all drivers below, main driver first.
Driver details*
Have any drivers listed above had any criminal convictions in the past 5 years?*

YesNo
If yes, please provide further details of conviction*
Have any drivers listed above had any claims or licence suspensions in the past 5 years?*

YesNo
If yes, please provide further details of claim/licence suspension*
Please indicate the excess you prefer for Commercial Motor

Declaration and authorisation
If any of the statements in this Application form are untrue, and you have suppressed or mis-stated any facts and/or should any information given by you alter between the date of this Application form and the inception date of the insurance to which this Application form relates you must immediately notify us.

You authorise us to collect or disclose any personal information relating to this insurance to any insurer or insurance reference service. Where you have provided information about another individual (for example, a relative, employee or client), you have or you will make the individual aware of that fact and the section in the Policy on "The way we handle your personal information".

You agree that you have read and understood this notice by doing any of the following:
(a) Signing this form; or
(b) Providing the information requested and returning the form to us; or
(c) Providing us with instructions to place the policy.
This request was completed by*

First NameLast Name
Are you filling this form out on behalf of another person?*

YesNo
Relationship to the insured if filling out this form on another's behalf*
E.g. relative, employee, client, power of attorney etc
I confirm I have checked all information contained in this document, and hereby verify the truth and accuracy of the information contained herewith.*

Yes
Please verify that you are human*
Type a question
Should be Empty:

COMMERCIAL MOTOR INSURANCE QUOTE

YOUR CONTACT DETAILS

POLICY DETAILS

DUTY OF DISCLOSURE

Commercial Motor Section

VEHICLE DETAILS

DRIVER DETAILS

Declaration and authorisation