PRINT FRIENDLY .... pdf document 1 vehicle   pdf document 1-3 vehicles   pdf document 1-5 vehicles      

Commercial Motor
This is for all vehicles with a carrying capacity over 2 tonnes, earthmoving equipment, bobcats, Skid steer loaders, graders, bulldozers and trailers. We are able to quote all classes of occupations - General freight, Tippers, Hazardous Goods, Livestock etc. and a variety of radiuses from local area to Australia Wide.

In order for City Rural Insurance Brokers to provide you with an Obligation Free Quote, please complete the following.

Fields designated in RED are required to be completed
PERSONAL INFORMATION
Registered owner
Street address
Suburb/Town
State
Postcode
Email Address
Phone
Fax
Mobile Phone
Preferred method of contact
Email    Phone    Fax
Occupation/Profession
GENERAL DETAILS
Depot
Holding broker
Current Insurer
Rating
Expiry
Owner/Driver:   Yes    No How long in business?
How Many Commercials?
VEHICLE 2
YearMakeModel
CCap  * Rego Body Type   *
Sum Insured
Do you want CTP? (NSW only)
Cover Type:
Comprehensive    Third Party Property Damage Only
CTP DETAILS 2
Renewal Period  Quarterly    Annually
Trucks GVM
 Kg
Postcode garaged
VEHICLE 3
YearMakeModel
CCap  * Rego Body Type   *
Sum Insured
Do you want CTP? (NSW only)
Cover Type:
Comprehensive    Third Party Property Damage Only
CTP DETAILS 3
Renewal Period  Quarterly    Annually
Trucks GVM
 Kg
Postcode garaged
VEHICLE 4
YearMakeModel
CCap  * Rego Body Type   *
Sum Insured
Do you want CTP? (NSW only)
Cover Type:
Comprehensive    Third Party Property Damage Only
CTP DETAILS 4
Renewal Period  Quarterly Annually   
Trucks GVM
 Kg
Postcode garaged
VEHICLE 5
YearMakeModel
CCap  * Rego Body Type   *
Sum Insured
Do you want CTP? (NSW only)
Cover Type:
Comprehensive    Third Party Property Damage Only
CTP DETAILS 5
Renewal Period  Quarterly    Annually
Trucks GVM
 Kg
Postcode garaged
Non Owned Trailer Insurance
What Limit?
Type
Hazardous Goods Insurance
What Limit?
What Classes and Amounts
Sub Contract Finance on Vehicles
For Who?
With Whom?
Radius
Goods Carried
Type of work
DRIVER DETAILS   *
Name
Date of Birth
How Long driving this type of Vehicle?
Were you an employed driver before?
How long for
Experience in other class of vehicles
Licence
CLAIMS - for all drivers
CONVICTIONS - for all drivers
Have you ever been Bankrupt? Yes No
If yes, please supply details
Have you had an insurance policy declined, cancelled? Yes No
If yes, please supply details
Have you lost your Licence in the past 5 years? Yes No
If yes, please supply details
Have You had any Criminal Convictions in the past 10 years? Yes No
If yes, please supply details
Do you drive on Airport Tarmacs? Yes No
If yes, please supply details
Do you want Load Insurance?   
LOAD INSURANCE DETAILS
Current Insurer 
Expiry date 
Limit for any one load
Gross freight earnings
Goods Carried
General Freight Heavy Machinery Household Effects
Bulk Dangerous Goods Livestock Refrigerated Goods Motor Vehicles
Other? Please specify
Claims
Cover

Fire, Lightning, Hail, Explosion, Flood, Collision and/or Overturning, Jack-knifing and Derailment of the Conveying Vehicle including Impact of any object not on or part of the Vehicle

Optional Cover

Theft and Non Delivery
Loading/Unloading
Accidental Damage (not always available)
Shedding of Load

Do you want Public Liability?   
PUBLIC LIABILITY DETAILS
Current Insurer 
Expiry date 
Annual estimated turnover     
Wages
Number of persons involved in business at any one time
Wages to sub contractors
Number of sub contractors involved
Claims History
Limit Required:   $5,000,000   $10,000,000  $20,000,000
I have read the Duty of Disclosure (view)
Duty of Disclosure

In order to make an informed assessment of the risk and calculate the appropriate premium, your insurer needs information about the risk you are asking it to insure.

For this reason, before you enter into a contract of insurance, you have a duty under the Insurance Contracts Act 1984 to disclose to your insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer’s decision whether to accept the risk and, if so, on what terms. The duty also applies when you renew, extend, vary or reinstate a contract of insurance.

You do not have to disclose anything that:

  • Reduces the risk to be undertaken by the insurer;
  • Is common knowledge;
  • Your insurer knows, or in the ordinary course of its business, ought to know; or
  • If the insurer has waived your obligation to disclose.
If you do not comply with your duty of disclosure, your insurer may be entitled to reduce its liability in respect of a claim or may cancel your contract of insurance. If the non-disclosure was fraudulent, the insurer may be able to avoid (or cancel) the contract of insurance from its beginning. This would have the effect that you were never insured.

One important matter to be disclosed is the history of losses suffered by the person seeking insurance or any closely associated person or entity. As you are responsible for checking that you have made complete disclosure, we suggest that you keep an up to date record of all such losses and claims.

Signature
Title
Dated

To Top

Member of National Insurance Brokers Association and Steadfast Group Limited

Australian Financial Services Licence No 237491 – General Insurance Broker

 

 

General Enquiry

Fill this in and send for a quick response.

Affiliations

SteadfastNiba