Step 1 of 5 - Personal information 20% Hi, let's get some details for your vehicle quote. Contact Name* First Last Email Address* Phone No* Tell us about Driver details.Name of Registered Owner* Tell us about Vehicle details.Vehicle Year/Make/Model*AccessoriesModificationsTransmission* Type of Cover Requested* Comprehensive (Unlimited kms) Comprehensive ‘Limited Kilometres’ (Limited to 5,001-8,000 kms per year) Comprehensive ‘Low Kilometres’ (Limited to 0 – 5,000 kms per year) Agreed Value*If Purchased in Last 12 monthsPurchase PricePurchase Date DD slash MM slash YYYY No Claim Bonus or Rating No*Select one60%/Rating 150%/Rating 240%/Rating 330%/Rating 420%/Rating 50%/Rating 6 Tell us more details about your vehicle.Use of Vehicle* Occupation*Finance* Yes No Financier*Address where vehicle is left overnight* Street Address City State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parked overnight in* 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. 1. Drivers less than 25 years of age not acceptable (30 in some cases). 2. Approved drivers must be licensed in Australia or New Zealand (provisional licenses excluded).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 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. Δ
