ABOUT USAbout Us Our Team Governance Why Us Testimonials Latest News Get aQUOTATION Make aCLAIM QUOTE REQUEST – DIRECT. Prestige Motor Vehicle Quotation Request For Direct Clients Your Duty When You Apply For Insurance By proceeding, you confirm that you have read the following important information. By law, you must take reasonable care not to make a misrepresentation. This means giving us true, complete and accurate answers to our questions, including where you provide information on someone else’s behalf. We use your answers to decide whether to insure you and on what terms. If any of your answers are misleading, incomplete, inaccurate or fraudulent we may reduce or not pay a claim, cancel your policy or treat it as if it never existed. If you don’t understand a question, you’re unsure how to answer or if anything is unclear, please call us. I acknowledge that I have read and understand My Duty When I Apply for Insurance* I Agree Contact Name* First Last Phone No*Email* Email me a copy Yes Please Name of Registered Owner*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 50%/Rating 6Use 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 systemDrivers Details*First NameLast Name% of UseDate of Birth (dd/mm/yyy) Please ensure % of Use totals to 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 resulted in a fine or demerit points being imposed or for which a conviction was recorded?YesNoPlease provide details:*Driver NameDescription of OffenceDatePenalty ImposedIf Speeding, kms over limit I have read the Financial Services Guide and the Product Disclosure Statement and Policy Wording. I acknowledge that I have read and agree to the Terms and Conditions and confirm I have complied with My Duty When I Apply for Insurance when answering these questions.* I Agree CAPTCHAReferrer 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
