REQUEST A QUOTE

Request A Quote

Company Name
Your Name (required)
Date of Birth (required) //
The first year you first obtained a drivers licence (required)
The type of licence you currently hold (required)

Please provide the following details for the youngest regular driver (if other than yourself):

Their Name
Date of Birth //
The first year they first obtained a drivers licence (eg 1995)
The type of licence they currently hold

Please provide details of any driver under 25 years old, not listed above:

Their Name
Date of Birth //
The first year they first obtained a drivers licence (eg 1995)
The type of licence they currently hold

Driving history of all the drivers of this vehicle (including the proposer)
SPECIAL NOTE: This section relates to your DRIVING and INSURANCE HISTORY and also includes the details for any drivers you allow to drive your vehicle. This is VERY IMPORTANT information on which we will base our decision to insure you (and any other drivers) and on what basis. If the information supplied is not absolutely accurate any claim lodged may be reduced or denied in total.

In the last 5 years has anyone driving this vehicle had:

1. A motor accident or damage of any kind even if you were not insured at the time? (if no go to question 2)?

For example

  • Was the other party at fault?
  • Were you or your driver at fault?
  • Was the vehicle damaged by a weather event? (Hail, Storm, Flood etc)
  • Was the vehicle stolen or burnt?
  • Was the vehicle maliciously damaged?
  • A windscreen or window glass was accidentally broken?
  • Was there a theft from the vehicle?
2. Have you or any driver had any driving conviction (if no go to question 3)?

For example

  • Have you been convicted for driving while your license was suspended?
  • Have you been convicted for any criminal act, Alcohol (DUI) or Drug related offences?
  • Have you been convicted for Dangerous driving, Culpable Driving, Causing death or similar?
  • Failure to stop after an accident?
  • Refused to undertake a blood, Breath or Drug test?
3. Have you had any driving offences? (if no go to question 4)?

For example

  • Have you been convicted any Driving Under the Influence (DUI) of alcohol or drugs?
  • Exceeding the speed limit by more than 30 Km/h?
  • Disobeying a Stop sign?
  • Not obeying a red light?
  • Negligent driving?
  • Had your licence suspended or accepted a period of good driving behaviour?
4. Have you been convicted for any other demerit offences not already mentioned? (This includes Speeding and any other offences not listed). (if no go to question 5)
5. Do you or any of the drivers suffer from any physical or mental disability or medical condition or are dependent on any drug or medication which could affect driving performance?
6. Have you or any driver had Insurance declined by another insurer? - you do not have to tell us if you were declined if:
a. Your previous insurer changed their rules and no longer offers the cover you require.
b. You have modified your vehicle to the extent where the insurer will no longer offer cover.
7. Have you or any driver had

  • a criminal conviction or charged with a criminal offence?

If the answer to any of the above questions was yes, we require complete information for each event If you are not completely sure of the details, you must confirm the information from the applicable motor transport authority or your previous insurer to ensure it is entirely correct.

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Please complete the following information about your vehicle:

Year of Manufacture (required)
Make (required)
Model / Description (required)
Condition of vehicle (required)
Is there any pre-existing damage to your vehicle? (required)
If yes selected above please describe the extent of the damage
Date Purchased (required)
Purchase Price (required)
Proposed Sum Insured (required)
Is your vehicle under finance? (required)
If yes above what is the name of the company?

Please provide the following identification information: (optional)

Registration Number (if unregistered type N/A)
Engine Number (required if vehicle is unregistered)
VIN / Chassis Number (required if vehicle is unregistered)

If you have previously had insurance on this vehicle, please provide

Current Insurer
Your No Claim Bonus (required)
Please select how you will be using the vehicle - refer to Types of Cover (required)
What security devices are fitted to the vehicle (required)
The vehicle is kept in (required)
Where is the vehicle garage stored at night?
Numbered Street Address (required)
Suburb (required)
Postcode (required)
State (required)
Please list all modifications, enter NONE if none apply: (required)
Please list all accessories, enter NONE if none apply: (required)
Are the following policy options required? (Full details of policy options can be found in the combined FSG PDS & Policy Wording Lifetime NCB protectionSalvage rights (vehicles must be over 15 years old)Spare parts cover (restoration cover only)Windscreen & glass cover (applies only to vehicles under 30 years old)Rental car after accident (applies only to Business and Regular Use vehicles)

Please provide your contact details

Home Phone:
Mobile Phone: (required)
Email: (required)
Preferred Method for us to contact you:
What's the best time to call:
Please list any other information we should know about you or your vehicle:
How did you hear about Enthusiast Underwriting: Car ClubFriends / FamilyGoogle / Search engineMagazine / publicationOther referralYellow / White Pages
I have read and agree with the Terms of Use and the Privacy Statement: (must be ticked to submit the form)