commercial motor vehicle insurance application

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "commercial motor vehicle insurance application"

Transcription

1 commercial motor vehicle insurance application

2 CGU Insurance Limited ABN lease read this page together with the roduct Disclosure Statement and olicy booklet before you complete the application, and retain these documents so you can refer to them again. What you need to tell us You must tell us everything that you know, or should know, could affect our decision to insure you and/or the terms on which we insure you. You must do this when you apply for a policy, renew your policy, and when you change or reinstate your policy. When we ask you specific questions, you must answer these questions truthfully and in a way that a reasonable person in the circumstances would answer them. It is important that every person who will be insured by the policy answers all questions in this way. These requirements are part of the Insurance Contracts Act What you do NOT need to tell us You do not need to tell us anything that: u reduces our risk. u is of common knowledge. u we know, or as an insurer should already know. u we tell you that we do not want to know. What will happen if you do not tell us If you withhold relevant information or you do not answer our questions in the way we have described, we can reduce the amount we pay for your claim, or we can cancel your policy. If your failure to tell us is fraudulent, or your answers are untruthful, we can treat your policy as if it never existed. When you are insured Your insurance begins when we accept your application. The commencement date of your insurance will be shown on the schedule that we will send you. The insurance applies for the period for which you have paid us (or agreed to pay us) the premium. You may pay your premium by cash, cheque or credit card. If your cheque or credit card is dishonoured by your financial institution, you are not insured. If you qualify, you can also pay your premium by instalments direct from a financial institution account or from your credit card. You cannot make a claim under this policy if you owed us more than one month s premium when the event about which you want to claim happened. If you pay your premium by instalments and you are more than one month behind, we can cancel your policy without notice. If you have a total loss, we may deduct the instalments for the balance of the period of insurance from the amount we pay you. Description of Cover Options Comprehensive Loss or damage to the insured vehicle up to its market value or sum insured whichever is the lower, and liability for damages arising from damage to other persons property up to the Limit of Indemnity, including legal costs. Fire, Theft and Third arty Loss or damage by fire or theft only to the insured vehicle up to its market value or sum insured whichever is the lower, and liability for damages arising from damage to other persons property up to the Limit of Indemnity, including legal costs. Third arty Only Liability for damages arising from damage to other persons property up to the Limit of Indemnity, including legal costs. When complete, please forward this application to: CGU Insurance, GO Box 9902 in the capital city of your state or your insurance adviser or your local CGU Insurance office.

3 CGU Insurance Limited ABN Commercial Motor Vehicle Insurance Application lease answer all questions. This will help us to process your application quickly. If you need more space to answer any of the questions, please use a separate sheet of paper. Any attachments will form part of this application and the declaration will include them. eriod of Insurance From Account no. Applicant(s) details To 4.00 p.m. on Agent or Broker olicy no. 2 : 4 : C : LOB = MVC : N : This Application replaces Cover te. Acceptance Names (include Trading As if applicable) Telephone ( ) rivate Bus. ostal address ostcode Business or occupation Details of All Regular Drivers Full name of regular drivers Date of birth Date licence obtained Expiry date of licence Occupation Approx. km driven per yr. Office Use Only REM LD : SEC : IN IN IN 100 2

4 Vehicles to be Insured (if insufficient space pl Veh. no. Registration or Serial Number Year of mnfr. RG RD Vehicle make and model, (include badge, body type - e.g. Holden Commodore SL sedan etc.) Engine size (litres) Carrying capacity (max. payload) of goods carrying vehicle Gross Vehicle Mass (tare plus max. payload) of goods carrying vehicle Current odometer reading Date of birth of usual driver Date of purchase Trailer (include no. of axles) Length (metres) Interested arties Is any other party(s) financially interested in any of the vehicles to be insured? If, state: Reg. or Serial no. Name of interested party Address ostcode Type of interest If space is insufficient attach a list in the same format as above. Limit of Indemnity Select LIMIT OF INDEMNITY for liability by ticking appropriate box: (Limit applicable to all vehicles) 20,000,000 Other (specify)

5 ease attach a list in the same format as below) urchase price Vehicles subject to finance (as detailed under Interested arties, below) roposed Sum Insured including accessories Comprehensive 562 Cover* Fire Theft and Third arty Third arty only Excess Where available, do you wish to pay extra to remove the standard excess? (Additional Excesses will still apply.) remium Goods and Services Tax Stamp Duty TOTAL *Only Comprehensive Cover is available for a trailer roposed Sum Insured for tarpaulins, gates and chains: AMOUNT AYABLE Office Use Only Veh.. 1 UNIT M/ CLASS : D C R YR YR REG. NUMBER T A N BI MA G VM VEH SN MAK OR RG : VOL. EXCESS : COM. EXCESS T S D EXOSURE 2 Veh UNIT : M/ CLASS D C R YR YR REG. NUMBER T A N BI MA G VM VEH VOL. EXCESS : SN : MAK OR RG : : : : COM. EXCESS T S D EXOSURE Questionnaire All questions must be answered by each of the Applicants and not by the agent or broker. If insufficient space, please provide additional details on a separate page. USE OF VEHICLES lease tick ( ) or and give details as requested. 1. Will the vehicles be used for purposes other than for private transport or in connection with the Applicant s business or occupation as stated in the Applicant panel on the first page? If, state the other uses 2. Will the vehicles be used to carry passengers for payment? lease turn over for further questions

6 lease tick ( ) or and give details as requested. 3. Will the vehicles be used to carry liquid fuel, toxic chemicals, organic peroxides, explosives or any corrosive, infectious or radioactive substance? If, a) Are there any drivers not licensed to drive in accordance with relevant regulations applicable for the carriage of such goods? b) Describe the method of carrying (e.g. drums, containers, etc.). c) State the usual type and quantity carried. 4. Will the vehicles be hired out to other operators? If, attach copies of hiring agreements. 5. From which base will the vehicles operate? 6. What is the normal area of operation of the vehicles? (If within a State, answer in kilometres) 7. Are your trailers ever coupled with other trailers and used as a Road Train, B-double etc.? 8. Do your vehicles have Australian compliance plates and do they comply with Australian design rules regarding safety and emission control? If to any part of the question, give details of the variations. 9. Are all your vehicles maintained in a roadworthy condition, in working order, free from mechanical defects and in an undamaged condition? If to any part of the question, give details. 10. Have any of your vehicles been modified or converted from the maker s specifications or fitted with accessories (costing more than 500 per item when new) other than those supplied as the maker s options? If, state: Reg. or serial no. DRIVING AND INSURANCE HISTORY 11. Have you, or any person who will drive any of your vehicles, Been charged with, or convicted of, or penalised for, any motoring offences in the last 5 years? This includes on the spot fines but does not include parking offences. Had a driving licence suspended, cancelled or restricted by endorsement in the last 5 years? If, complete details below. Full name of person Details of modification, alteration, adaptation or fitting Date of offence Nature of offence or endorsement Date of conversion Blood alcohol % reading Value of fittings enalty, fine or bond imposed

7 lease tick ( ) or and give details as requested. 12. Have you, or any person who will drive any of your vehicles, been charged with, or convicted of, any criminal offences in the past 10 years? If, complete the details below. Full name of person Date of offence Details of the charge, conviction, prosecution, penalty, fine or bond imposed 13. Have you, or any person who will drive any of your vehicles, had insurance cover cancelled or refused or had any special terms imposed by an insurer? (lease read the inside cover of this application before you answer this question.) If, complete details below. Full name of person Name of insurance company Action taken by insurance company Date of offence 14. Have you, or any person who will drive any of your vehicles, been involved in a motor vehicle accident, had a vehicle burnt or stolen, or claimed against an insurance company for damage to a vehicle, in the past 5 years? If, complete details below. Full name of person Date of occurrence Brief details (e.g. hit other vehicle in rear) Reg. no. of own vehicle Own damage Other damage Own insurance company s name Was a claim submitted to the insurance company? Full name of person Reg. no. of own vehicle Date of occurrence Brief details (e.g. hit other vehicle in rear) Own damage Other damage Own insurance company s name Was a claim submitted to the insurance company? 15. a) Name of previous insurer olicy number b) Do you currently have a Claims Bonus entitlement for any vehicle for which you are now applying for Comprehensive cover? If, attach the previous insurer s expiry or renewal notice. c) If the previous insurer s notice is for a different vehicle, do you still own that vehicle? DISCLOSURE AND DECLARATION 16. Are there any exceptional circumstances relating to the risk to be insured that you have not already told us about, and that you know or should know may affect our decision to insure you? If, please provide details on a separate page and attach to this application. 17. I/We declare that: a) the information in this application is true and correct and I/we have not withheld any relevant information. b) I/we agree to accept the insurance subject to the terms, conditions, exclusions and limitations of the policy. I/We authorise CGU Insurance to obtain or supply details of insurance claims and other relevant information. I/We authorise CGU Insurance to collect or disclose any personal information relating to this insurance to/from any other insurers or insurance reference service. If you do not wish to receive any marketing material directly from us (such as special offers and discounts) tick this box. Signature of the Applicant Date Signature of the Applicant Date lease indicate the number of additional pages attached to this application

8 contact details New South Wales and ACT 388 George Street Sydney NSW 2000 t (02) f (02) Corporate Reception t (02) f (02) Victoria 485 La Trobe Street Melbourne VIC 3000 t (03) f (03) Queensland 189 Grey Street South Bank QLD 4101 t (07) f (07) Website: South Australia and NT 80 Flinders Street Adelaide SA 5000 t (08) f (08) Tasmania 188 Collins Street Hobart TAS 7000 t (03) f (03) Western Australia 46 Colin Street West erth WA 6005 t (08) f (08) Insurer CGU Insurance Limited ABN C0001 REV8 3/08

motor vehicle insurance application for privately owned non-commercial vehicles (excluding motorcycles) motor vehicle

motor vehicle insurance application for privately owned non-commercial vehicles (excluding motorcycles) motor vehicle motor vehicle insurance application for privately owned non-commercial vehicles (excluding motorcycles) motor vehicle CGU Insurance Limited ABN 27 004 478 371. An IAG Company. Please read the following

More information

MOTOR VEHICLE PROPOSAL FORM

MOTOR VEHICLE PROPOSAL FORM Commercial and Trucksure Pty Ltd As agent for the Insurer ABN: 78 078 661 220 AFSL: 238151 Level 6, 3 Spring Street Sydney NSW 2000 PO Box R1940 Royal Exchange NSW 1225 Telephone: (02) 9251 1155 Facsimile:

More information

COMMERCIAL / BUSINESS MOTOR VEHICLE FLEET INSURANCE QUESTIONNAIRE

COMMERCIAL / BUSINESS MOTOR VEHICLE FLEET INSURANCE QUESTIONNAIRE COMMERCIAL / BUSINESS MOTOR VEHICLE FLEET INSURANCE QUESTIONNAIRE Current Broker Claim Bonus / Rating Entitlement Current Insurer Expiry Date Contact Name Postal Address Phone Fax Mobile Website Email

More information

boat insurance application

boat insurance application boat insurance application CGU Marine Insurance A Division of CGU Insurance Limited ABN 27 004 478 371 Please read the following information carefully. Tear off this page and keep for your reference. Your

More information

MOTOR VEHICLE ACCIDENT CLAIM REPORT

MOTOR VEHICLE ACCIDENT CLAIM REPORT MOTOR VEHICLE ACCIDENT CLAIM REPORT CGU Insurance Limited ABN 27 004 478 371 Please retain this page for your information ABOUT YOUR CLAIM Please obtain one quotation for the repair of your vehicle from

More information

Motor Vehicle. Claim Report

Motor Vehicle. Claim Report Motor Vehicle Claim Report Please retain this page for your information IMPORTANT INFORMATION ABOUT YOUR CLAIM This form must be completed and signed by the person who was driving your vehicle, or the

More information

Motor Vehicle. Claim Report

Motor Vehicle. Claim Report Motor Vehicle Claim Report Please retain this page for your information IMPORTANT INFORMATION ABOUT YOUR CLAIM This form must be completed and signed by the person who was driving your vehicle, or the

More information

motor vehicle insurance for privately owned non-commercial vehicles motor vehicle theft claim report Insurer CGU Insurance Limited ABN 27 004 478 371

motor vehicle insurance for privately owned non-commercial vehicles motor vehicle theft claim report Insurer CGU Insurance Limited ABN 27 004 478 371 motor vehicle insurance for privately owned non-commercial vehicles motor vehicle theft claim report Insurer CGU Insurance Limited ABN 27 004 478 371 CGU Insurance Limited ABN 27 004 478 371 Please retain

More information

motor vehicle motor vehicle insurance for privately owned non-commercial vehicles accident claim report

motor vehicle motor vehicle insurance for privately owned non-commercial vehicles accident claim report motor vehicle insurance for privately owned non-commercial vehicles motor vehicle accident claim report Insurer CGU Insurance Limited ABN 27 004 478 371 An IAG Company CGU Insurance Limited ABN 27 004

More information

first choice home insurance application first choice home

first choice home insurance application first choice home first choice home insurance application first choice home CGU Insurance Limited ABN 27 004 478 371. An IAG Company. Please read the following information before you complete the application. Keep this

More information

Liability Package for Associations and Non-profit Organisations

Liability Package for Associations and Non-profit Organisations Liability Package for Associations and n-profit Organisations Answer all questions. Blanks or dashes, or answers known to underwriters or brokers or N/A are unacceptable & will delay consideration of this

More information

Motor Vehicle. Claim Form PLEASE RETURN COMPLETED FORM TO YOUR JLT OFFICE:

Motor Vehicle. Claim Form PLEASE RETURN COMPLETED FORM TO YOUR JLT OFFICE: Motor Vehicle Claim Form PLEASE RETURN COMPLETED FORM TO YOUR JLT OFFICE: GPO Box 1693 ADELAIDE SA 5001 Tel +61 (0)8 8235 6446 Fax +61 (0)8 8235 6448 PO Box 925 ALBURY NSW 2640 Tel +61 (0)2 6057 3333 Fax

More information

Suburb State Postcode Residential address. Suburb State Postcode

Suburb State Postcode Residential address. Suburb State Postcode Classic and Collector Vehicle & Motorcycle Insurance quotation & proposal form Broker or dealer details Company Name Phone Email Page 1 of 7 The applicant Full name Date of birth Email Postal address Phone

More information

MOTOR FLEET INSURANCE PROPOSAL FORM

MOTOR FLEET INSURANCE PROPOSAL FORM 1. Details of Proposer(s): Trading Name (If any): Correspondence Address: Tel: Fax: Mobile: E-mail: Business or Occupation: Company website address (if any): 2. Details of Vehicles: Sr.. Manufacture Make

More information

MOTORCYCLE INSURANCE QUESTIONNAIRE

MOTORCYCLE INSURANCE QUESTIONNAIRE MOTORCYCLE INSURANCE QUESTIONNAIRE Contact Details Contact Person Postal Address Phone Number Company Name (if applicable) Postcode Email Address Cover Type Comprehensive Agreed Value Third Party, Fire

More information

MOTOR VEHICLE CLAIM FORM (Accident or Theft)

MOTOR VEHICLE CLAIM FORM (Accident or Theft) Cowden Group MOTOR VEHICLE CLAIM FORM (Accident or Theft) The supply or acceptance of this form is not an admission of liability on the part of your Insurer 1. Your Details Policy No Expiry of Insured

More information

Public and Products Liability Proposal Form

Public and Products Liability Proposal Form Public and Products Liability Proposal Form Solution Underwriting Agency Pty Ltd Level 5, 289 Flinders Lane Melbourne, Victoria. Australia 3000 T. 03 9654 6100 F. 03 9654 6200 www.solutionunderwriting.com.au

More information

heavy motor Product Profile

heavy motor Product Profile heavy motor Product Profile Heavy Motor Product Profile Lumley Insurance Heavy Motor provides insurance protection via market leading wordings, risk management and claims service, delivering holistic risk

More information

MOTOR VEHICLE CLAIM FORM

MOTOR VEHICLE CLAIM FORM MOTOR VEHICLE CLAIM FORM How to obtain a quick response to your claim: 1. Make sure that you fully answer all questions 2. Attach a copy of the Driver s Licence for the driver of the vehicle at the time

More information

Motor Trade Road Risks. Proposal Form

Motor Trade Road Risks. Proposal Form Motor Trade Road Risks Proposal Form PLEASE ANSWER ALL QUESTIONS FULLY IN BLOCK CAPITALS If there is insufficient space for any answers please continue on the back page 1. PROPOSER Mr Mrs Miss Ms Surname

More information

Couriers insurance package form

Couriers insurance package form Page 1 of 5 Couriers insurance package form Important Information Duty of Disclosure Before you enter into a contract of insurance, you have a duty under the Insurance Contracts Act 1984 (Cth) to disclose

More information

PROPOSAL FORM. Fleet Heavy Motor Vehicle Insurance. Page 1 of 7. Important Notices Please read these Important Notices before completing the Proposal.

PROPOSAL FORM. Fleet Heavy Motor Vehicle Insurance. Page 1 of 7. Important Notices Please read these Important Notices before completing the Proposal. PROPOSAL FORM Fleet Heavy Motor Vehicle Insurance Important Notices Please read these Important Notices before completing the Proposal. Duty of Disclosure Under the Insurance Contracts Act 1984 (the Act),

More information

Your. Product Disclosure Statement and Insurance Policy

Your. Product Disclosure Statement and Insurance Policy Your Product Disclosure Statement and Insurance Policy In arranging this insurance Credit Union Australia Limited ABN 44 087 650 959 AFSL No. 238317 is acting pursuant to an agreement with the Insurer

More information

Just Car Comprehensive Car Insurance Premium, Excesses & Claims Guide

Just Car Comprehensive Car Insurance Premium, Excesses & Claims Guide Just Car Insurance Agency Pty Ltd. ABN 41 050 238 563. GPO Box 4663, Melbourne, Victoria 3001. 601 St Kilda Road, Melbourne, Victoria 3004. telephone 13 13 26 facsimile 1300 325 813 www.justcarinsurance.com.au

More information

MOTOR VEHICLE ACCIDENT Claim Report

MOTOR VEHICLE ACCIDENT Claim Report MOTOR VEHICLE ACCIDENT Claim Report HBA General Insurance and Mutual Community General Insurance Insurer: Mutual Community General Insurance Pty Ltd Abn 59 007 895 543 Please retain this page for your

More information

MOTOR VEHICLE QUOTATION PROPOSAL FORM

MOTOR VEHICLE QUOTATION PROPOSAL FORM MOTOR VEHICLE QUOTATION PROPOSAL FORM THE PROPOSER Full Insured Name Trading Name(s) ABN ACN Postal Address Contact Name State Position Post code Telephone No ( ) Facsimile No Mobile No Website E-mail

More information

Professional Indemnity Insurance Proposal Form for Engineers and Construction Professionals

Professional Indemnity Insurance Proposal Form for Engineers and Construction Professionals Professional Indemnity Insurance Proposal Form for Engineers and Construction Professionals Answer all questions. Blanks &/or dashes, or answers known to underwriters or brokers or N/A are not acceptable

More information

liability insurance application liability Insurer CGU Insurance Limited ABN 27 004 478 371 An IAG Company

liability insurance application liability Insurer CGU Insurance Limited ABN 27 004 478 371 An IAG Company liability insurance application liability Insurer CGU Insurance Limited ABN 27 004 478 371 An IAG Company Extract from the Insurance Contracts Act 1984 Under the terms of the Act We must advise You about

More information

Motor Vehicle Insurance product disclosure statement and insurance policy

Motor Vehicle Insurance product disclosure statement and insurance policy product disclosure statement and insurance policy Preparation date: 30 November 2007 Insurer: Swann Insurance (Aust) Pty Ltd ABN 80 000 886 680. AFS Licence No. 238292. Table of contents This booklet is

More information

Motor Vehicle Insurance

Motor Vehicle Insurance Motor Vehicle Insurance Your Guide to Premium, Excesses, Discounts and Claim Payments all states except Victoria The insurer is GIO General Limited ABN 22 002 861 583 AFSL 229873. This product is distributed

More information

Directors & Officers Liability and Corporate Reimbursement Insurance Proposal Form

Directors & Officers Liability and Corporate Reimbursement Insurance Proposal Form Directors & Officers Liability and Corporate Reimbursement Insurance Proposal Form Answer all questions. Blanks and/or dashes, or answers known to underwriters/brokers or N/A are not acceptable and will

More information

Office. insurance information

Office. insurance information Office insurance information CGU Office Package provides all-in-one protection for people who operate their business from an office, including medical and health, financial services, professionals, consultants

More information

DAWES MOTOR INSURANCE MOTOR VEHICLE CLAIM FORM IMPORTANT NOTICES

DAWES MOTOR INSURANCE MOTOR VEHICLE CLAIM FORM IMPORTANT NOTICES DAWES MOTOR INSURANCE MOTOR VEHICLE CLAIM FORM PO Box 2717 Taren Point NSW 2229 Telephone: 1300 188 299 Facsimile: 1300 662 215 Email: claims@dawes.com.au www.dawes.com.au Before completing this claim

More information

Corporate Advantage Management Liability Insurance Proposal Form

Corporate Advantage Management Liability Insurance Proposal Form Corporate Advantage Management Liability Insurance Proposal Form Answer all questions. Blanks and/or dashes, or answers known to underwriters/brokers or N/A are not acceptable and will delay consideration

More information

Quotation Request and Proposal

Quotation Request and Proposal Quotation Request and Proposal Richard Bowen 0800 287 287 Managing Broker MultiSure Ltd 86 Normandale Road, Lower Hutt 5010 Ph: (04) 589 3319 Fax: (04) 587 0258 Email: richard@multisure.co.nz Philip Toohill

More information

Commercial Motor and Motor Fleet Claim Form

Commercial Motor and Motor Fleet Claim Form Commercial Motor and Motor Fleet Claim Form The completion of this form and its receipt by us is not an indication that we accept any liability. Please print in block letters and answer all Questions where

More information

Home Insurance. Claim Report

Home Insurance. Claim Report Home Insurance Claim Report CGU Insurance Limited ABN 27 004 478 371 AFSL 238291 Please retain this page for your information About your claim Most policies allow for replacement of property with the nearest

More information

Professional Indemnity Insurance Application Form for Eligible Midwives

Professional Indemnity Insurance Application Form for Eligible Midwives Professional Indemnity Insurance Application Form for Eligible Midwives This Form will be used by MIGA to consider your application for Professional Indemnity Insurance with MIGA and for your automatic

More information

Autovan Commercial Motor Insurance Proposal form

Autovan Commercial Motor Insurance Proposal form Autovan Commercial Motor Insurance Proposal form Agent s name Agent s number Policy number te: Please use BLOCK CAPITALS and tick YES or NO where appropriate. Please initial any alterations. A. Proposer

More information

Public Relations / Marketing Consultants. Professional Indemnity Insurance

Public Relations / Marketing Consultants. Professional Indemnity Insurance Public Relations / Marketing Consultants Public Relations Consultants Marketing Consultants Market Research Consultants Advertising Consultants Graphic Designers Professional Indemnity Insurance Proposal

More information

REAL ESTATE AGENTS & PROPERTY MANAGERS PROFESSIONAL INDEMNITY PROPOSAL FORM

REAL ESTATE AGENTS & PROPERTY MANAGERS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICES CLAIMS-MADE INSURANCE REAL ESTATE AGENTS & PROPERTY MANAGERS PROFESSIONAL INDEMNITY PROPOSAL FORM This policy is issued on a claims-made basis. This means that the policy only covers

More information

Motor Vehicle Accident Claim Form

Motor Vehicle Accident Claim Form Motor Vehicle Accident Claim Form THE COMPLETION OF THIS FORM AND ITS RECEIPT BY US IS NOT AN INDICATION THAT WE ACCEPT ANY LIABILITY. WE HAVE QUALITY REPAIRERS TO HELP YOU IN THE EVENT OF A CLAIM. PLEASE

More information

BERKLEY INSURANCE AUSTRALIA IMPORTANT NOTICES: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL

BERKLEY INSURANCE AUSTRALIA IMPORTANT NOTICES: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL Fleet Motor Insurance Proposal BERKLEY INSURANCE AUSTRALIA IMPORTANT NOTICES: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into a contract

More information

IBNA Secure Car Motor Vehicle Insurance Product Disclosure Statement and Policy Wording

IBNA Secure Car Motor Vehicle Insurance Product Disclosure Statement and Policy Wording IBNA Secure Car Motor Vehicle Insurance Product Disclosure Statement and Policy Wording Product Disclosure Statement The purpose of this Product Disclosure Statement (PDS) is to help you understand the

More information

AAMI THIRD PARTY PROPERTY DAMAGE MOTORCYCLE INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE

AAMI THIRD PARTY PROPERTY DAMAGE MOTORCYCLE INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE AAMI THIRD PARTY PROPERTY DAMAGE MOTORCYCLE INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE This AAMI Third Party Property Damage Motorcycle Insurance Premium, Excesses & Claims Guide (Guide) is designed to

More information

1. Your Details 2. Insured Vehicle Description

1. Your Details 2. Insured Vehicle Description MOTOR VEHICLE CLAIM The issue or acceptance of this form is not to be construed as an admission of liability on the part of the company. Shaded areas for office use only. Please print clearly. Claim Number

More information

Motor Vehicle. Accident Claim Form COMPLAINTS PROCEDURE. Financial Ombudsman Service. Privacy Statement. General Insurance Code of Practice

Motor Vehicle. Accident Claim Form COMPLAINTS PROCEDURE. Financial Ombudsman Service. Privacy Statement. General Insurance Code of Practice COMPLAINTS PROCEDURE Enthusiast Underwriting Pty Ltd is a member of the Financial Ombudsman Service. This independent service is provided to the insuring public at no cost and aims to resolve claims complaints

More information

Business. insurance information

Business. insurance information Business insurance information A The CGU Business Package is designed to meet the needs of Australian small-to-medium sized businesses. Whether you are a manufacturer, importing or storage, retailer, service

More information

home insurance home claim report

home insurance home claim report home insurance home claim report CGU Insurance Limited ABN 27 004 478 371. An IAG Company. Please retain this page for your information About your claim Most policies allow for replacement of property

More information

1. NAME OF FIRM TO BE INSURED 2. ADDRESS OF FIRM 3. THE FIRM. (please include full names of all entities to be insured) Phone ( ) Email

1. NAME OF FIRM TO BE INSURED 2. ADDRESS OF FIRM 3. THE FIRM. (please include full names of all entities to be insured) Phone ( ) Email SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au MISCELLANEOUS PROFESSIONAL INDEMNITY

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM Answer all questions. Blanks &/or dashes, or answers known to underwriters or brokers or N/A are not acceptable & will delay consideration of this proposal.

More information

Professional Indemnity Insurance Application

Professional Indemnity Insurance Application Professional Indemnity Insurance Application Office Use Only Core Customer Segment Account Number Policy Number Important Notices Duty of Disclosure Before you enter into a contract of insurance with Ansvar

More information

Professional Indemnity Insurance Application Form Marsh Accountants Insurance Program

Professional Indemnity Insurance Application Form Marsh Accountants Insurance Program Professional Indemnity Insurance Application Form Marsh Accountants Insurance Program Phone: 1300 093 634 Email: accountants@marsh.com tice to the Applicant This notice must be read before you complete

More information

AAMI COMPREHENSIVE CAR INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE

AAMI COMPREHENSIVE CAR INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE AAMI COMPREHENSIVE CAR INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE Your Guide to Premiums, Excesses, Discounts and Claim Payments This AAMI Comprehensive Car Insurance Premium, Excesses & Claims Guide (Guide)

More information

Motor Vehicle Insurance. Your guide to Premiums, Excesses, Discounts and Claim Payments

Motor Vehicle Insurance. Your guide to Premiums, Excesses, Discounts and Claim Payments Motor Vehicle Insurance Your guide to Premiums, Excesses, Discounts and Claim Payments Your guide to Premiums, Excesses, Discounts and Claim Payments The purpose of this guide is to provide further detail

More information

CGU Padlock. insurance application

CGU Padlock. insurance application CGU Padlock insurance application CGU Insurance Limited ABN 27 004 478 371 Please read the following information before you complete the application. Keep this information for your records. Please read

More information

specified contract works and legal liability proposal

specified contract works and legal liability proposal W000001 specified contract works and legal liability proposal for building construction contracts Important Notices relating to this Proposal You should read the following comments and the Declaration

More information

4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director

4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au ACCOUNTANTS PROFESSIONAL INDEMNITY

More information

Comprehensive Motor Vehicle Insurance

Comprehensive Motor Vehicle Insurance Comprehensive Motor Vehicle Insurance Premium, Excess and Claims Guide Preparation date: 1 March 2014 toyotainsurance.com.au Contents Introduction 1 How we calculate your premium 2 Pricing factors 2 Changes

More information

COMPREHENSIVE MOTOR VEHICLE INSURANCE. Premium, Excess and Claims Guide

COMPREHENSIVE MOTOR VEHICLE INSURANCE. Premium, Excess and Claims Guide COMPREHENSIVE MOTOR VEHICLE INSURANCE Premium, Excess and Claims Guide Preparation Date: 1 March 2014 CONTENTS Page INTRODUCTION... 2 HOW WE CALCULATE YOUR PREMIUM... 2 Pricing factors... 3 Changes in

More information

HAULAGE VEHICLE INSURANCE. Proposal Form November 2004 Edition

HAULAGE VEHICLE INSURANCE. Proposal Form November 2004 Edition HAULAGE VEHICLE INSURANCE Proposal Form vember 2004 Edition Important tice To apply for the Haulage Vehicle Insurance Policy, complete this Proposal Form in BLOCK CAPITALS using a ball-point pen (blue

More information

fleetshield proposal form

fleetshield proposal form fleetshield proposal form FOR OFFICE USE ONLY: Policy.: Authorised: Agency: Broker/Agent: Quote Ref.: premium: A full policy wording is available on request Important: It is an offence under the ROAD TRAFFIC

More information

MOTORCYCLE CLAIM FORM ACCIDENT DAMAGE (The issue of this form is not an admission of liability)

MOTORCYCLE CLAIM FORM ACCIDENT DAMAGE (The issue of this form is not an admission of liability) MOTORCYCLE CLAIM FORM ACCIDENT DAMAGE (The issue of this form is not an admission of liability) This form should be completed and forwarded to - ECHELON CLAIMS SERVICES GPO Box 1693 Adelaide SA 5001 Facsimile:

More information

Motor Vehicle Insurance Claim

Motor Vehicle Insurance Claim Motor Vehicle Insurance Claim The supply or acceptance of this form is not an admission of liability on the part of the insurer. Please complete ALL sections of this claim form. Unless specifically arranged

More information

Apia Car Advantage Your guide to Premiums, Excesses and Claims Guide

Apia Car Advantage Your guide to Premiums, Excesses and Claims Guide Apia Car Advantage Your guide to Premiums, Excesses and Claims Guide Rewarding experience Australian Pensioners Insurance Agency Pty Ltd ABN 14 099 650 996 AR No. 239591 is an agent and authorised representative

More information

Professional Indemnity Insurance Proposal Form Miscellaneous

Professional Indemnity Insurance Proposal Form Miscellaneous Commercial & General Insurance Brokers (Aust) Pty Ltd Suite 4, 1016 Doncaster Road Doncaster East Victoria 3109 Phone: 1300 764 244 Fax: 03 8841 4299 Email: pi@cgib.com.au Web: www.cgib.com.au AFS License:

More information

COMMERCIAL VEHICLE INSURANCE PROPOSAL

COMMERCIAL VEHICLE INSURANCE PROPOSAL Tradewise Insurance Services Ltd COMMERCIAL VEHICLE INSURANCE PROPOSAL SUMMARY OF COVER This is a brief outline only - a copy of the policy wording including all terms and conditions may be obtained on

More information

MOTOR VEHICLE CLAIM FORM

MOTOR VEHICLE CLAIM FORM MOTOR VEHICLE CLAIM FORM The Issue of this Form is not an Admission of Liability by Insurers We understand the difficulties arising from your accident. Please complete and return this claim form as soon

More information

AAMI COMPREHENSIVE CAR INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE

AAMI COMPREHENSIVE CAR INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE AAMI COMPREHENSIVE CAR INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE This AAMI Comprehensive Car Insurance Premium, Excesses & Claims Guide (Guide) is designed to provide you with additional information about

More information

Landlords Insurance. Application

Landlords Insurance. Application Landlords Insurance Application Landlords Insurance Application Form Important Information Product Disclosure Statement This application is for Australian Unity Landlords Insurance. Please read the product

More information

Proposal Form and Important Notices. Motor Car and Motorcycle Insurance

Proposal Form and Important Notices. Motor Car and Motorcycle Insurance t h e e n t h u s i a s t s c h o i c e Proposal Form and Important Notices Motor Car and Motorcycle Insurance T h e E n t h u s i a s t s C h o i c e Insured by certain Underwriters at Lloyd s. Administered

More information

BOAT INSURANCE QUESTIONNAIRE

BOAT INSURANCE QUESTIONNAIRE BOAT INSURANCE QUESTIONNAIRE Current Broker Current Insurer Policy Number Expiry Date Contact Name Postal Address Phone Fax Mobile Email INSURED PERSON Insured 1 Full Name Insured 2 Full Name HULL : :

More information

BUSINESS PACKAGE PROPOSAL

BUSINESS PACKAGE PROPOSAL BUSINESS PACKAGE PROPOSAL RM Insurance Company (PRIVATE) LIMITED RM 317A INDEX SECTION S. PAGES 1 Fire 1 2 Business Interruption 2 3 3 All Risks 3 4 Theft 4 5 Money 4 6 Glass 5 7 Goods in Transit 5 8 Liability

More information

Motor Equity Insurance. Policy Document (Product Disclosure Statement) 216469 POL373 Alph cov_d1.indd 2 6/03/13 12:47 PM

Motor Equity Insurance. Policy Document (Product Disclosure Statement) 216469 POL373 Alph cov_d1.indd 2 6/03/13 12:47 PM Motor Equity Insurance Policy Document (Product Disclosure Statement) 216469 POL373 Alph cov_d1.indd 2 6/03/13 12:47 PM Preparation Date: 01/03/2013. 216469 POL373 Alph cov_d1.indd 3 6/03/13 12:47 PM Table

More information

PERSONAL INSURANCE. product disclosure statement and policy

PERSONAL INSURANCE. product disclosure statement and policy PERSONAL INSURANCE Strata Motor insurance Vehicle insurance policy product disclosure statement and policy motor vehicle insurance product disclosure statement and policy motor vehicle About Aon Personal

More information

Leaders in Marine and Transit Insurance Expertise Service Security

Leaders in Marine and Transit Insurance Expertise Service Security Builders Risks Insurance PROPOSAL Leaders in Marine and Transit Insurance Expertise Service Security Builders Risks Proposal Information you will want to know about this Insurance. THE POLICY As a ship

More information

Apia Car Advantage Your guide to Premiums, Excesses and Claims Guide

Apia Car Advantage Your guide to Premiums, Excesses and Claims Guide Apia Car Advantage Your guide to Premiums, Excesses and Claims Guide Rewarding experience Australian Pensioners Insurance Agency Pty Ltd ABN 14 099 650 996 AR No. 239591 is an agent and authorised representative

More information

Specialists at minimising risk exposure. Professional Indemnity Insurance Insurance Proposal Form

Specialists at minimising risk exposure. Professional Indemnity Insurance Insurance Proposal Form Specialists at minimising risk exposure Professional Indemnity Insurance Insurance Proposal Form Professional Indemnity Insurance Application Office Use Only Core Customer Segment Account number Policy

More information

Motor Vehicle Insurance

Motor Vehicle Insurance Product Disclosure Statement and insurance policy Insurer: Preparation date: 10 August 2011 Swann Insurance (Aust) Pty Ltd ABN 80 000 886 680 AFS Licence No. 238292 Table of contents This PDS is important

More information

MOTOR VEHICLE INSURANCE PROPOSAL FORM

MOTOR VEHICLE INSURANCE PROPOSAL FORM MOTOR VEHICLE INSURANCE PROPOSAL FORM In completing the Proposal Form please ensure that questions are answered fully and accurately and where necessary schedules giving further explanation are provided.

More information

Professional Indemnity Proposal

Professional Indemnity Proposal Professional Indemnity Proposal IMPORTANT NOTICES Your Duty Of Disclosure This Policy is subject to the Insurance Contracts Act 1984. Under that Act you have a duty of disclosure. Before you take out insurance

More information

Motor Vehicle Insurance

Motor Vehicle Insurance Motor Vehicle Insurance Premium, Excess and Claims Guide Preparation date: 1 August 2012 toyotainsurance.com.au Contents Introduction 1 How we calculate your premium 2 Your premium 2 Premium discounts

More information

Certificate of Currency

Certificate of Currency Certificate of Currency Po Box 3714 South Brisbane QLD 4101 Date: Invoice No: 29.09.2014 I0122265 We confirm insurance has been arranged in accordance with the details shown below and subject to the premium

More information

Home. Insurance information

Home. Insurance information Home Insurance information CGU s home insurance policy is designed to fully meet your home and contents insurance needs, whether you are a family, a working couple, single, a retiree or just starting out

More information

landlords residential property insurance information

landlords residential property insurance information YOUR INSURANCE INFORMATION landlords residential property insurance information This is general advice only and does not take into account your individual objectives, financial situation or needs ( your

More information

Professional Indemnity Insurance AILA Proposal

Professional Indemnity Insurance AILA Proposal Professional Indemnity Insurance AILA Proposal September 2013 Please return this completed proposal to: Lynn Wainstein Lauren Malkin Tel (03) 9613 1442 Tel (03) 9613 1423 Email Lynn.Wainstein@jlta.com.au

More information

AAMI COMPREHENSIVE MOTORCYCLE INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE

AAMI COMPREHENSIVE MOTORCYCLE INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE AAMI COMPREHENSIVE MOTORCYCLE INSURANCE PREMIUM, EXCESSES & CLAIMS GUIDE This AAMI Comprehensive Motorcycle Insurance Premium, Excesses & Claims Guide (Guide) is designed to provide you with additional

More information

Medical, Health & Allied Establishments Malpractice Insurance Proposal Form

Medical, Health & Allied Establishments Malpractice Insurance Proposal Form Medical, Health & Allied Establishments Malpractice Insurance Proposal Form Answer all questions. Blanks &/or dashes, or answers known to underwriters or brokers or N/A are not acceptable & will delay

More information

DAWES MOTOR INSURANCE MOTORCYCLE CLAIM FORM IMPORTANT NOTICES

DAWES MOTOR INSURANCE MOTORCYCLE CLAIM FORM IMPORTANT NOTICES DAWES MOTOR INSURANCE MOTORCYCLE CLAIM FORM P.O. Box 2717 Taren Point NSW 2229 Phone: 1300 188 299 Fax: 1300 662 215 claims@dawes.com.au To ensure prompt attention to your claim, please complete this form

More information

NRMA Motor Insurance Premium, Excess & Discounts Guide NSW

NRMA Motor Insurance Premium, Excess & Discounts Guide NSW 1 NRMA Insurance Premium, Excess & Discounts Guide NSW This NRMA Insurance Premium, Excess and Discounts Guide should be read with the NRMA Insurance Product Disclosure Statement and Policy Booklet (PDS)

More information

2. The Insured (Vehicle owner)

2. The Insured (Vehicle owner) mobile plant liability claim form WFI Insurance Limited, ABN 24 000 036 279 The issue of this form must not be taken as an admission of liability. Form is to be completed as far as possible by the driver

More information

Purchase Price Protection Insurance

Purchase Price Protection Insurance Product Disclosure Statement and insurance policy Insurer: Preparation date: 1 September 2011 Swann Insurance (Aust) Pty Ltd ABN 80 000 886 680 AFS Licence No. 238292 Table of contents This PDS is important

More information

Affinity 4WD. Insurance

Affinity 4WD. Insurance Affinity 4WD Insurance Welcome to Affinity 4WD Insurance Affinity Insurance Brokers (Affinity) are pleased to provide you with a motor vehicle insurance policy specifically designed for 4WD owners and

More information

Autovan Commercial Motor Insurance Proposal form

Autovan Commercial Motor Insurance Proposal form Autovan Commercial Motor Insurance Proposal form Agent s name Agent s number Policy number te: Please use BLOCK CAPITALS and tick YES or NO where appropriate. Please initial any alterations. A. Proposer

More information

Motor Equity Insurance. Product Disclosure Statement and Policy Document.

Motor Equity Insurance. Product Disclosure Statement and Policy Document. Motor Equity Insurance Product Disclosure Statement and Policy Document. Table of contents About this Insurance page Our Product Disclosure Statement 3 Understanding your policy and its important terms

More information

Just Car Third Party Property Damage Car Insurance Premium, Excesses & Claims Guide

Just Car Third Party Property Damage Car Insurance Premium, Excesses & Claims Guide Just Car Insurance Agency Pty Ltd. ABN 41 050 238 563. GPO Box 4663, Melbourne, Victoria 3001. 601 St Kilda Road, Melbourne, Victoria 3004. telephone 13 13 26 facsimile 1300 325 813 www.justcarinsurance.com.au

More information

MOTOR FLEET PROPOSAL FORM

MOTOR FLEET PROPOSAL FORM MOTOR FLEET PROPOSAL FORM One Coval Wells Chelmsford Essex CM1 1WZ Tel: 01245 272700 Fax: 01245 272701 QBE European Operations is a trading name of QBE Insurance (Europe) Limited, no. 01761561 ( QIEL ),

More information

Motor Vehicle Insurance Claim. Insured

Motor Vehicle Insurance Claim. Insured Suite 5 & 6 156 Oxford St, Leederville WA 6007 PO Box 495, Leederville WA 6903 Freecall: 1800 776 747 Facsimile: 1800 194 525 Email: info@mynfib.com.au ABN 23 108 296 064 National Franchise Insurance Brokers

More information

Claim Form. Motor Vehicle. Section 1 (To be completed by Owner): Occupation. Name of insured. Address. Phone No [ ] Year Model.

Claim Form. Motor Vehicle. Section 1 (To be completed by Owner): Occupation. Name of insured. Address. Phone No [ ] Year Model. Section 1 (To be completed by Owner): Policy no Name of insured Occupation Expiry Date Phone No [ ] Make of Vehicle Mileage Registration No Year Model Co-Owner In whose name is the registered? For what

More information

Public & Products Liability Proposal Form Standard

Public & Products Liability Proposal Form Standard Public & Products Liability Proposal Form Standard IMPORTANT NOTICES Your Duty Of Disclosure This Policy is subject to the Insurance Contracts Act 1984. Under that Act you have a duty of disclosure. Before

More information