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Off Road Bike, Atv & Go-kart Insurance Proposal Form

Broker or dealer details

The applicant

Postal address
Residential and garaging address

The cover

Period of insurance
Finance:

If yes,
Has the vehicle been uninsured during the last 30 days?:

Vehicle details

Modifications: Means that your vehicle 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 fixed items which do not affect the performance or handling of the vehicle.

Does your vehicle have any non-standard accessories?:

Do you have a security device fitted to your vehicle?:

How would you rate the overall vehicle condition?:


In the last 5 years, have you or any other person to be covered under this policy:

Made a claim on any motor insurance policy?:

Suffered a loss or damage to a motor vehicle for which you did not claim or were not insured for?:

If you have answered “Yes” to either question please describe the circumstances below.
1.
2.
3.
4.
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 fines, offences, charges, infringements, convictions or disqualifications (excluding parking fines)?:

1.
2.
3.
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?:

Important notices – please read

Vehicle: means the motorcycle, dirt bike or go kart specified on your One Underwriting Certificate of Insurance. It includes any accessory attached to the vehicle which is listed on your One Underwriting Certificate of Insurance.

What does this policy cover me for?

One Underwriting Off Road Bike Insurance policy provides cover for your vehicle (including any accessory attached to it) in the event of loss or damage caused by the following events anywhere in Australia:

  • damage to the vehicle while in transit – caused by the collision or overturning of the conveying vehicle and/or trailer transporting the vehicle;
  • fire, lightning, explosion, storm and earthquake; and
  • theft of the vehicle – provided that the vehicle is secured by chain and lock to a fixed object at the time of the theft and stored within a fully enclosed locked building when kept at the garaging address.
What is not covered by this policy?

This policy does not cover the following:

  • damage caused while loading and unloading your vehicle onto or from conveyance or trailer;
  • wear and tear, gradual deterioration, mechanical or electrical breakdown;
  • damage caused during use of your vehicle, including use for hire;
  • any legal liability whatsoever.
Are there any important policy conditions that I should be aware of?

The following important conditions apply to your cover:

  • your vehicle must be secured with a lock and chain to a fixed object at all times when not in use; and
  • your vehicle must be stored within a fully locked and housed within an enclosed building when kept at the garaging address.

This brochure only provides a summary of the cover provided. For full details of the cover, including policy conditions and exclusions, please refer to the Off Road Bike Insurance Policy available from One Underwriting on request.

How much will my cover cost?

The premium is based on the market value of your vehicle. To find out how much you have to pay simply refer to the price table. For a quote on multiple vehicles please call our office on 07 3223 7517.

Basis of claims settlement

The insurer can choose either to repair, replace, pay you the cost of repairing your vehicle or pay you up to current market value (or replacement value if your vehicle is less than 12 months old and you are the original owner) – less the appropriate excess. Settlement includes accessories fitted to your vehicle which are not standard for that make and model.

What policy excess will be deducted if I make a claim?

Standard Excess – an excess of $250 will be deducted for all claims except in the event of theft.

Theft Excess – an excess of $500 will be deducted for theft claims.

How do I arrange cover?

Simply complete the attached application form in full and forward it to us at the address shown. No contract is entered into until your payment and application form is received and approved by us.

Who do I contact if I have questions?

We have dedicated staff on hand to answer your questions.

Please call us on 07 3223 7517 or by email to motorsolutions@oneunderwriting.com.au or visit our website www.oneunderwriting.com.au and we will be happy to help.

Duty of Disclosure

Before you enter into a contract of insurance, you have a duty under the Insurance Contracts Act 1984 (Cth) to disclose anything that you know, or could reasonably be expected to know, that may affect the insurer’s decision to insure you and on what terms. You have that duty after proposal, and up until the time the insurer agrees 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 the insurer 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 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 it 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.

Declaration

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 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. I/We acknowledge what is covered by this policy and what is not covered and have read the Important Notices attaching to this Proposal Form. 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 Insurer and its Coverholder

  • 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.

Payment

Note: Insurance cover will not commence until your application has been accepted and your payment processed by One Underwriting Pty Ltd. Policy documents will be sent to your postal address provided in this application.

Please insert the amount payable ($)

Cheque/Money Order attached:

Credit card payment*:


*Credit card surcharge applies: Visa and Mastercard 1.5%, Amex 3%.

Short Form Privacy Disclosure and Consent

Application/Claim Forms
  1. One Underwriting Pty Ltd (‘OU’) 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 OU 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 OU Privacy Notice. Further information about our privacy practices can be located in the OU Privacy Policy, a copy of which can also be sent to you on request by your OU representative. You may also gain access to your personal information, or modify your privacy preferences, by contacting your OU representative or our Privacy Officer through the means set out in the OU Privacy Notice.
  2. If you are disclosing personal or sensitive information about any other person to OU, you confirm that you have obtained the consent of that person to disclose to OU their personal or sensitive information and you have made them aware that OU 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 OU, you will inform us before providing the relevant information to us.

By submitting this Quotation & Proposal Off Road Bike | ATV | Go-Kart Insurance, you acknowledge that you have read the OU Privacy Notice and agree that we can handle any personal information you have provided to us in the manner set out above

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