ABOUT USAbout Us Our Team 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 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 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
