Motorhome Insurance Quote Form

Important information

Please read each of the following notices before proceeding. By ticking 'I agree' you confirm you have done so and:

You have read and downloaded the Financial Services Guide(FSG) and Product Disclosure Statement(PDS);
You agree to receive FSG and PDS documents electronically including via hyperlink to our website; and
You confirm that the asset that is the subject of this quotation is and will remain located in Australia and will be used for private personal purposes only and not for any commercial or business use.

Your Duty to take Reasonable Care not to make a Misrepresentation

Before buying insurance, you have a duty under the Insurance Contracts Act 1984 (Cth) to take reasonable care not to make a misrepresentation to us.

In the following sections, we'll ask you questions that are relevant to our decision about whether to insure you and if so, on what terms. When you answer the questions you must not give a false or misleading account of matters. Your response should tell us everything that you know about the question.

Consequences of failure to take reasonable care not to make a misrepresentation

If you breach your duty, we may cancel your insurance or reduce the amount we pay if you make a claim, or both.

If your failure to take reasonable care not to make a misrepresentation is fraudulent, we may refuse to pay a claim and treat your policy as if it never existed.

Further information

The Product Disclosure Statement contains more information about this duty including circumstances relevant to it.

Privacy Collection Statement

We are committed to protecting your privacy.

We collect the personal information we need to assess insurance applications, provide quotations, issue insurance policies and assess claims made under them. We may not be able to do these things if you don't provide the information we need.
We provide your personal information to the insurer that underwrites your insurance and our related companies. We provide your name and policy number to any intermediary that arranged your policy or referred you to us. We may also provide relevant personal information to our trusted suppliers including financiers, loss adjusters, assessors, repairers, professional advisers, document storage centres, mailing houses and IT software / service providers, some of whom may be based or controlled in the United States.

If you make a claim, we may also need to provide relevant personal information to authorities (such as the police, licensing and registration bodies and the Australian Financial Security Authority) and to other insurers in the event of recovery or litigated action.

We may use your contact details to send you information and marketing communications that we believe will be of interest to you. You can opt out from receiving these at any time.

Our Privacy Policy contains more information about how we manage your information including how you can access it, ask us to correct it or make a privacy related complaint. This is available free of charge on our website and on request by telephone: (02) 8920 1157 or email:[email protected]

If you provide us with personal information about another person, you must have their consent to do so and give them the information in this statement.

Financial Services Guide

Our Financial Services Guide provides important information about our services.

Product Disclosure Statement

Please download and carefully read the current Motorhome Product Disclosure Statement to fully understand the policy.

Target Market Determination

We have prepared a Target Market Determination (TMD) for each of our retail products. This describes the class of consumers that comprises the target market for the relevant product and certain matters relevant to its distribution and review. Our TMDs can be accessed here.

I agree:

Yes No

About your Motorhome

Style:

Motorhome

Make:

Motorhome not listed:

Yes No

If your motorhome make is not listed click here and enter for referral.

Other Motorhome Make:

Motorhome Year:

Motorhome Model:

Purchase price:

$

Purchase date:

Motorhome Model:

Who is your current insurer?

Are you the first registered owner of this Motorhome?

Yes No

Motorhome Sum Insured:

$

Please elect the sum insured / agreed value that reflects the value of your motorhome in the current market, including any accessories and/or aftermarket improvements.

What is the intended use of your Motorhome?

Private

Commercial

Business

Is / will your motorhome be road registered?

Yes No

Please provide details:

Does the Motorhome have any pre-existing damage?

Yes No

Please provide details:

Has your Motorhome ever been written off or listed as a repairable write off previously?

Yes No

Please provide details:

Motorhome Storage

Storage Method:

Commercial storage name:

Address finder:

Address not listed

Address line 1:

Address line 2:

Suburb:

State:

Postcode:

Insured and Contact Details

Date Of Birth:

Contact Number:

Email:

Address finder:

Address not listed:

Address line 1:

Address line 2:

Suburb:

State:

Postcode:

Licence Type:

Do you permanently reside in your Motorhome?

Yes No

Has the insured(s) in the last 5 years had any insurance refused or cancelled?

Yes No

Please provide details:

Has the insured(s) ever had any Motorhome, Caravan or motor related theft claims in the last five years?

Yes No

Please provide details:

Has the insured(s) ever been convicted of any offence in the last 5 years?

Yes No

Please provide details:

Has the insured(s) in the last 5 years ever had their motor licence suspended or revoked for any reason?

Yes No

Please provide details:

Has the insured(s) had any at fault accidents over the last 3 years?

Yes No

Please provide details:

Has the insured(s) ever have any medical conditions, which may affect their driving capacity?

Yes No

Please provide details:

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