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Collector & Specialty and Motorcycle Quote and Proposal Form

Broker or dealer details


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?:
Have you owned this type of vehicle/motorcycle previously?:
Are you a car/motorcycle Club Member?:
Do you own other vehicles/motorcycle?:
Is this vehicle/motorcycle, your primary form of transport?:
Will the vehicle/motorcycle normally be driven on weekends/holidays only?:
Will the applicant/s be the only driver/s using this vehicle/motorcycle?:
(A) Is the vehicle/motorcycle restored? or:
(B) Do you intend to do so?:
Do you consider yourself as a motoring/motorcycle enthusiast or collector?:
Do you or have you participated in motorsport activities or advanced driver/rider training?:
Do you have a current policy with One Underwriting?:

The applicant

Must be the same as the registered owner.
Period of insurance
Postal address
Residential address
Is the residential address the overnight parking?:
How is the vehicle/motorcycle parked overnight?:
Is the daytime parking address the same as overnight?:
How is the vehicle/motorcycle parked during the day?:

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.

If you are requesting a reduced usage cover i.e. Limited Use or Extreme Limited Use, please complete the following;
Is the Odometer functioning correctly?:

Vehicle details

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?:
Does your vehicle/motorcycle have any non-standard accessories?:
Do you have a security device fitted?:
How would you rate the overall vehicle/motorcycle condition?:

Do you wish to insure for your vehicle for:

If Agreed Value

Are there additional spare parts to be insured at your home location only?:
Has the vehicle been uninsured during the last 30 days?:
Are you entitled to a No Claim Bonus or discount?:
No Claim Bonus:

Vehicle use

For what purpose will you use your vehicle/motorcycle? (Business use unacceptable.):

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.

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?:
Suffered a loss or damage to a motor vehicle/cycle for which you did not claim or were not insured for?:
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?:
Had any traffic offences, charges, infringements, convictions or disqualifications (excluding parking fines)?:
Suffer from any illness or disability, likely to affect driving/riding ability?:
Had any claims refused, insurance policy declined, cancelled or had special terms imposed?:
Declared bankrupt and not discharged within the last 12 months, or currently involved in bankruptcy or repossession proceedings.:


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.

Important notices

  • This Insurance is underwritten by Certain Underwriters at Lloyd’s. The names and percentages of the applicable syndicates are available upon request to One Underwriting Pty Ltd. You can contact Lloyd’s in Australia at; Lloyd’s Underwriters’ General Representative in Australia, Level 9, 1 O’Connell Street, Sydney NSW 2000, Telephone (02) 8298 0700.
  • One Underwriting acts as an agent of Certain Underwriters at Lloyd’s in arranging and entering into this motor insurance, not the Insured.
  • This quotation is valid only for a period of thirty (30) days and may be withdrawn or varied at any time by us.
  • By submitting the request for quotation you confirm that you have read and agree to the terms of the Privacy Notice sent to you by us.
  • In submitting the information you are acting as agent of the proposed insured(s) and are doing so on their behalf.

Our Product Disclosure Statement

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:

Your Duty of Disclosure:

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:

  • reduces the risk that is insured;
  • is common knowledge;
  • Your insurer knows or should know as an insurer; or
  • the insurer waives compliance with your duty of disclosure.

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.

Non Disclosure:

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.

Short Form Privacy Disclosure and Consent

  1. One Underwriting Pty Ltd is committed to protecting your personal information in accordance with the Australian Privacy Principles under the Privacy Act 1988 (Cth). We collect, use and disclose personal information to offer, promote, provide, manage and administer our various insurance services we are involved in as set out in the One Underwriting Privacy Notice. In order to do this, we may also share your information with other persons or entities who assist us in providing or promoting our services as set out in the One Underwriting Privacy Notice. Further information about our privacy practices can be located in the One Underwriting Privacy Policy, a copy of which can also be sent to you on request by your One Underwriting representative. You may also gain access to your personal information, or modify your privacy preferences, by contacting your One Underwriting representative or our Privacy Officer through the means set out in the One Underwriting Privacy Notice.
  2. If you are disclosing personal or sensitive information about any other person to One Underwriting, you confirm that you have obtained the consent of that person to disclose to One Underwriting their personal or sensitive information and you have made them aware that One Underwriting will or may disclose their information to third parties that are reasonably necessary to assist in the provision of the relevant services or products. If you have not obtained consent from this other person to disclose their personal or sensitive information to One Underwriting, you will inform us before providing the relevant information to us.

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.

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