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Vehicle Details

 

Your vehicle details are:

Registration Number:

VIN Number:

Registration State:

Odometer Reading:

Date of First Registered:

Make & Model:

Are the vehicle details correct?

Are you purchasing the vehicle now?

Quotation Information

 

Your Quote details are:

PRODUCT:
TITLE
TERM: 12 MONTHS 24 MONTHS 36 MONTHS
PREMIUM:
MONTHLY:

Your Information

 

Please complete your details:

Insured Type:

Male Female

Correspondence Address:

Contact Details:


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Vehicle Information

 

Please complete your details:

Yes No
Used New

Acknowledgement Information

 

Your Quote and Acknowledgement:

(Click here for PDS)

Before we can provide you with cover on your vehicle, please acknowledge the following:

The vehicle covered in this policy has been mechanically serviced as per vehicle Manufacturer guidelines.

The vehicle covered in this policy does not have existing damage or mechanical problems and is in a roadworthy condition.

If the vehicle covered in this policy does not have existing Manufacturer or Dealer Statutory Warranty cover, a 90 day no claim period is applied to this policy.

Prior to the purchase of cover, you understand your legal rights and protection under the Australian Consumer Law.

Prior to the purchase of cover, you have read the Product Disclosure Statement (PDS) and Product Summary Features and Benefits and understand the level of cover being provided.

Payment Information

 

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