ABOUT USAbout Us Our Team Governance Why Us Testimonials Latest News Get aQUOTATION Make aCLAIM QUOTE REQUEST – BROKERS. Prestige Motor Vehicle Quotation Request For Insurance BrokersBrokerage*State*Please Select...QLDVICNSWSAACTTASWANTContact Name*Phone No*Broker Email* Email me a copy Yes Please Client Name*Vehicle Year/Make/Model*AccessoriesModificationsTransmission*ManualAutomaticTiptronicType 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 Price:Purchase Date Date Format: DD slash MM slash YYYY No Claim Bonus or Rating No*Select One60%/Rating 150%/Rating 240%/Rating 330%/Rating 420% Rating 5NoneUse of Vehicle*PrivateBusinessOccupation*Finance*YesNoFinancier*Suburb where vehicle is left overnight*Postcode*Parked overnight in*GarageCarportDrivewayOtherIf Other*(Overnight street parking at or near the nominated parking facility is not acceptable.)Security Device Fitted?*YesNoIf yes, details of immobiliser or tracking systemDriver Details*First NameLast Name% of UseDate of Birth (dd/mm/yyyy) Please ensure % of Use totals 100% across all drivers.Note: 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 above drivers had any accidents, vehicles stolen or burnt, or any other losses involving a vehicle where an insurance claim has been made?*YesNoPlease provide details*Driver NameDescription of LossDate of LossCost of Loss In the LAST THREE (3) YEARS have any of the above drivers committed any traffic offences which have resulted in a conviction or for which a penalty has been imposed or points lost?*YesNoPlease provide details:*Driver NameDescription of OffenceDatePenalty ImposedIf Speeding, kms over limit Your Duty of Disclosure Before you enter into an insurance contract, you have a duty of disclosure under the Insurance Contracts Act 1984. If we ask you questions that are relevant to our decision to insure you and on what terms, you must tell us anything that you know and that a reasonable person in the circumstances would include in answering the questions. You have this duty until we agree to insure you. Who Needs to Tell Us It is important that you understand you are answering our questions in this way for yourself and anyone else whom you want to be covered by the policy. If You Do Not Tell Us Something If you do not tell us anything you are required to tell us, we may cancel your contract or reduce the amount we will pay you if you make a claim, or both. If your failure to tell us is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed. CAPTCHA GET STARTED. Get aQUOTATION Make aCLAIM DOWNLOADS CLAIMS QUOTATIONS CONTACT FSG | TERMS OF USE | PRIVACY POLICY | COMPLAINTS | ABN 96 070 982 106 | © MB INSURANCE GROUP PTY LIMITED
