Work vehicle insurance questions
Please answer all questions and then press submit.
1. Have you held your open licence for more than two years?
*
Yes
No
2. Have you been under a licence suspension or cancellation, or restricted licence during the last 5 years?
*
Yes
No
3. Have you had any alcohol or drug related driving charges or dangerous driving charges within the last 3 years?
*
Yes
No
4. Have you reached maximum driving licence demerit points in the last 3 years or taken a good behaviour bond instead?
*
Yes
No
5. Regardless of fault, in the last 5 years have you had any car-related claims, accidents, thefts or losses including if the vehicle was not driven at the time?This includes incidents where there was no claim or someone else made a claim.If yes, provide details:
*
Yes
No
If you answered yes, please provide details:
6. Has an insurance company cancelled or refused to renew insurance for you in the last 5 years?
*
Yes
No
7. Have you been convicted of a criminal offence? Note: they do not want to know about convictions or offences that the law permits you to not disclose.
*
Yes
No
8. Where will the car be parked?
*
Driveway
Garage
Street
What is the address?
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Street Address
Street Address Line 2
Suburb
Postal / Zip Code
9. Do you own another vehicle that you hold insurance on?
*
Yes
No
If you answered yes, please provide details:
What is the registration no of the work vehicle you will be driving (if known):
Is there a fuel card with the vehicle, and what is the number on it?
Is there a Linkt toll tag with the vehicle, and what is the number on it?
Name
*
First Name
Last Name
Date
*
 -
Day
 -
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Submit
Should be Empty: