Broker or dealer details |
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Eligibility |
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The One Underwriting Collector Vehicle Insurance is designed for the motor vehicle collector and/or enthusiast. In order for us to consider your application we’d like to know some more about you. |
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The applicant |
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Must be the same as the registered owner. |
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Period of insurance |
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Postal Address |
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Residential address |
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The cover |
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If the vehicle is not driven on a regular basis You can select an annual kilometer limitation in return for a premium saving. In choosing a limited annual kilometer option you agree to advise Us if You will exceed the limitation without delay. If You exceed the kilometer limitation an additional premium and/or excess may be payable. If you are insured for Concessional/Club registration and increase the vehicle’s registration status to full registration without informing Us, You may not be insured. |
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If you are requesting a reduced usage cover i.e. Limited Use or Extreme Limited Use, please complete the following; |
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Vehicle details |
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Modifications: means that your vehicle/motorcycle has alterations to the engine, drive train, suspension or wheels other than by the manufacturers design. |
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Vehicle use |
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All people who will drive/ride your vehicle or motorcycle |
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You must nominate all regular drivers/riders i.e. those who will drive/ride the vehicle/motorcycle more than 12 times a year. |
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In the last 5 years have you or any other person likely to drive/ride your vehicle/motorcycle |
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I/We agree on my own behalf and on behalf of all other insured persons that: the within statements are true. The Duty of Disclosure has been complied with. The Vehicle/Motorcycle described is and shall be maintained in an appropriate condition. When signing the Proposal/Quotation Form, I/We acknowledge that should some or all of the answers stated in this form NOT be in my/our own handwriting, the answers have been checked and I/We certify they are correct and that I/We agree to accept a policy subject to the terms, exceptions and conditions prescribed therein. The vehicle/motorcycle to be insured shall not be driven/ridden by any person under 30 years of age (or as otherwise prescribed on Your Policy Schedule). The vehicle/motorcycle to be insured shall not be driven/ridden by any person who to my/our knowledge has been refused any motor insurance or the continuance thereof. The Product Disclosure Statement (PDS) for this policy may be made available as described in the “Our Product Disclosure Statement” notice. I/We have read and agree to the terms of the Privacy Notice.
The law requires that you receive a “Product Disclosure Statement” (PDS) prepared by Certain Underwriters at Lloyd’s. The PDS aims to give you enough information to decide whether to buy this product. Lloyd’s PDS is made up of a number of documents. The Proposal and the PDS and Policy Wording Booklet contains the standard terms and conditions of cover. If cover is issued, the Schedule other documents we tell you are included, will update and becomes part of the PDS. These documents are available to you (if you or your agent does not already have them, by calling us, visiting our office or website: oneunderwriting.com.au)
Before you enter into a contract of insurance, you have a duty under the Insurance Contracts Act 1984 (Clth)to disclose anything that you know, or could reasonably be expected to know, that may affect our decision to insure you and on what terms. This includes your driving record and insurance history for the previous five (5) years and any criminal convictions whether current or spent for the previous ten (10) years prior to the inception of, or renewal of the insurance Policy.
You have that duty after proposal, and up until the time we agree to insure you. You have the same duty before you renew, extend, vary or reinstate a contract of insurance.
You do not need to tell us anything that:
If you are uncertain about whether or not a particular matter should be disclosed to the insurer, please contact Us or your appointed insurance broker.
If you do not tell your insurer anything you are required to, the insurer may cancel your contract or reduce the amount that is required to pay you if you make a claim, or both. If your failure to disclose is fraudulent, the insurer may refuse to pay a claim and treat the contract as if it never existed.
By submitting this Quotation & Proposal Securus Motor Insurance, you acknowledge that you have read the One Underwriting Privacy Notice and agree that we can handle any personal information you have provided to us in the manner set out above Unless you tick here, we or any of our group of companies may be in touch by any means (including email or SMS) at any time to let you know about goods, services or promotions that may be of interest to you.