One Underwriting - Motor Solutions | Products

Mobile Plant & Construction

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Mobile Plant & Construction

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Mobile Plant & Construction 2

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Broker or dealer details
Company:
Name:
Phone:
Email:
Eligibility
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.
Has the vehicle/motorcycle just been purchased?:	YesNo
Have you owned this type of vehicle/motorcycle previously?:	YesNo
Are you a car/motorcycle Club Member?:	YesNo
Include details here of enthusiast club membership details:
Do you own other vehicles/motorcycle?:	YesNo
Is this vehicle/motorcycle, your primary form of transport?:	YesNo
Will the vehicle/motorcycle normally be driven on weekends/holidays only?:	YesNo
Will the applicant/s be the only driver/s using this vehicle/motorcycle?:	YesNo
(A) Is the vehicle/motorcycle restored? or:	YesNo
(B) Do you intend to do so?:	YesNo
Do you consider yourself as a motoring/motorcycle enthusiast or collector?:	YesNo
Do you or have you participated in motorsport activities or advanced driver/rider training?:	YesNo
Do you have a current policy with One Underwriting?:	YesNo
The applicant
Must be the same as the registered owner.
Title:	MrMrsMissMsDr
First name:
Famliy name:
Phone:
Email:
Occupation:
Date of birth:
Period of insurance
From:
To:
Postal address
Street:
Suburb:
State:
Postcode:
Residential address
Street:
Suburb:
State:
Postcode:
Is the residential address the overnight parking?:	YesNo
Street:
Suburb:
State:
Postcode:
How is the vehicle/motorcycle parked overnight?:	Locked garageCarportDrivewayCar parkOn street
Is the daytime parking address the same as overnight?:	YesNo
Street:
Suburb:
State:
Postcode:
How is the vehicle/motorcycle parked during the day?:	Locked garage Carport Driveway Car park On street
Street:
Suburb:
State:
Postcode:
The cover
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.
Comprehensive – (Daily & Commuting Use) Comprehensive – Daily (Non-Commuting Use) Comprehensive – extreme limited <3,000km per year Comprehensive – limited <6,000km per year Laid Up/Storage Cover Only Comprehensive – concessional cover/club registration
If you are requesting a reduced usage cover i.e. Limited Use or Extreme Limited Use, please complete the following;
What is the current Odometer Reading?:
Is the Odometer functioning correctly?:	YesNo
Vehicle details
Year:
Make:
Model:
Capacity and cylinders:
Registration number:
Vin/chassis number:
Engine number:
Purchase price/value:
Body type:
Purchase date:	Today
Modifications: means that your vehicle/motorcycle has alterations to the engine, drive train, suspension or wheels other than by the manufacturers design. Accessories: an accessory is an item fitted by a dealer or non standard item or items not fitted by the manufacturer, such as tinted windows, alloy wheels and other fixed items which do not affect the performance or handling of the vehicle/motorcycle.
Has your vehicle/motorcycle been modified?:	YesNo
If Yes describe all modifications and their values.:
Does your vehicle/motorcycle have any non-standard accessories?:	YesNo
If Yes describe the accessories and their values.:
Do you have a security device fitted?:	YesNo
If Yes please provide details.:
How would you rate the overall vehicle/motorcycle condition?:	New vehicle Good for its age condition Average or less, requires restoration Newly restored/concours

At what value do you wish to insure your vehicle/motorcycle (including modifications and accessories, ie proposed agreed value)?:	$
Are there additional spare parts to be insured at your home location only?:	YesNo
Finance:	YesNo
If Yes, finance type and name of provider.:
Has the vehicle been uninsured during the last 30 days?:	YesNo
If Yes, please provide details why not.:
Are you entitled to a No Claim Bonus or discount?:	YesNo
No Claim Bonus:	Nil 10% 20% 30% 40% 50% 60% 60% Protected
Insurer name:
Policy number:
Vehicle use
For what purpose will you use your vehicle/motorcycle? (Business use unacceptable.):	Private Wedding Hire Other
If other, please describe:
All people who will drive/ride your vehicle or motorcycle
You must nominate all regular drivers/riders i.e. those who will drive/ride the vehicle/motorcycle more than 12 times a year.
1.
First name:
Family name:
Date of birth:
Year licence obtained:
Licence number:
% use:
2.
First name:
Family name:
Date of birth:
Year licence obtained:
Licence number:
% use:
In the last 5 years have you or any other person likely to drive/ride your vehicle/motorcycle
Made a claim on any motor insurance policy?:	YesNo
Suffered a loss or damage to a motor vehicle/cycle for which you did not claim or were not insured for?:	YesNo
1.
Details of loss:
Driver’s name:
Person at fault:
Cost:
Date of loss:	Today
Insurer:
2.
Details of loss:
Driver’s name:
Person at fault:
Cost:
Date of loss:	Today
Insurer:
3.
Details of loss:
Driver’s name:
Person at fault:
Cost:
Date of loss:	Today
Insurer:
Are there any additional accident/claim matters to disclose?:	Yes No
If yes provide details of all additional accident/claim matters.:
Had any traffic offences, charges, infringements, convictions or disqualifications (excluding parking fines)?:	YesNo
1.
Date of incident:	Today
Person involved:
Details of charges, offences, infringements, convictions or disqualifications:
Amount of fine, penalty or disqualification period:
2.
Date of incident:	Today
Person involved:
Details of charges, offences, infringements, convictions or disqualifications:
Amount of fine, penalty or disqualification period:
3.
Date of incident:	Today
Person involved:
Details of charges, offences, infringements, convictions or disqualifications:
Amount of fine, penalty or disqualification period:
Are there any additional traffic matters to disclose?:	Yes No
If yes provide details of all additional traffic matters.:
In the last 10 years, been convicted of, or had any fines or penalties imposed for any crime involving drugs, dishonesty, arson, theft, fraud or violence against any person or property?:	YesNo
If Yes, please provide details.:
Suffer from any illness or disability, likely to affect driving/riding ability?:	YesNo
If YES, please provide details.:
Had any claims refused, insurance policy declined, cancelled or had special terms imposed?:	YesNo
If YES, please provide details.:
Declared bankrupt and not discharged within the last 12 months, or currently involved in bankruptcy or repossession proceedings.:	YesNo
If YES, please provide details.:

Collector & Specialty and Motorcycle Quote and Proposal Form

Broker or dealer details

Eligibility

The applicant

Period of insurance

Postal address

Residential address

The cover

If you are requesting a reduced usage cover i.e. Limited Use or Extreme Limited Use, please complete the following;

Vehicle details

Vehicle use

All people who will drive/ride your vehicle or motorcycle

In the last 5 years have you or any other person likely to drive/ride your vehicle/motorcycle

Declaration

Important notices

Our Product Disclosure Statement

Your Duty of Disclosure:

Non Disclosure:

Short Form Privacy Disclosure and Consent

We provide cover for:

Key Benefits:

Why One Underwriting?

Resources

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