One Underwriting - Motor Solutions | Products

Important notices

This Insurance is underwritten HDI Global Specialty SE, (ABN 58 129 395 544, AFS Licence number 458776), with its registered address at Tower 1, Level 33, 100 Barangaroo Avenue, Sydney NSW, 2000. Telephone (02) 8373 7580.
One Underwriting acts as an agent of HDI Global Specialty SE 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This quotation is valid only for a period of thirty (30) days and may be withdrawn or varied at any time by us.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 HDI Global Specialty SE. The PDS aims to give you enough information to decide whether to buy this product. The PDS is made up of a number of documents. The Proposal (or declaration) 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)

I agree.

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.

I agree.

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.

I agree.

Broker or dealer details
Company:
Name:
Phone:
Email:
Period of insurance
From:
To:
Occupation:
The applicant
Full name:
Overnight address
Street:
Suburb:
State:
Postcode:
Is the residential address the overnight parking location?:	Yes No
Street:
Suburb:
State:
Postcode:
If No please advise location?
Street:
Suburb:
State:
Postcode:
How is the vehicle parked overnight?:	Locked Garage Unlocked Garage Carport Driveway Car park On Street Other
Other:
How is the vehicle parked during the day?:	Locked Garage Unlocked Garage Carport Driveway Car park On Street Other
Other:
The cover
What type of cover?:	Comprehensive – (Daily & Commuting Use) Daily – (Non-Communting Use) Comprehensive – extreme limited <4,000km per year Comprehensive – limited <8,000km per year Third party property liability only $20,000,000 Comprehensive – concessional cover/club registration
Vehicle details
Year:
Make:
Model:
Body type:
Capacity and cylinders:
Vin/Chassis number:
Registration number:
Purchase date:
Purchase price/value ($):
Finance:	Yes No
If Yes, finance type and name of provider.:
Has your vehicle been modified?:	Yes No
If yes, describe all modifications and their values.:
Do you wish to insure your vehicle for:	agreed value market value
If agreed value, at what value do you wish to insure your vehicle? (Including modifications and accessories i.e. proposed agreed value):
Are you entitled to a No Claim Bonus or Discount?:	Yes No
No Claim Bonus:	Nil 10% 20% 30% 40% 50% 60% Rating 1 Protected
Vehicle Use
For what purpose will you use your vehicle/motorcycle?:	Private Business
If Business, please provide details:
All people who will drive your vehicle
You must nominate all people who will drive your vehicle i.e. those who will drive the vehicle more than 12 times a year. All drivers must have held an appropriate Australian Drivers Licence for more than 5 years. Drivers aged under 25 years (30 in some cases) and over 80 years are excluded or as specified on the schedule.
1.
First name:
Family name:
Date of Birth:
% use:
2.
First name:
Family name:
Date of Birth:
% use:
3.
First name:
Family name:
Date of Birth:
% use:
4.
First name:
Family name:
Date of Birth:
% use:
In the last 5 years, have you or any other person likely to drive your vehicle
Had any traffic offences, charges, infringements, convictions or disqualifications (excluding parking fines)?:	Yes No
1.
Date of incident:
Person involved:
Amount of fine, penalty or disqualification period:
Details of charges, offences, infringements, convictions or disqualifications:
2.
Date of incident:
Person involved:
Amount of fine, penalty or disqualification period:
Details of charges, offences, infringements, convictions or disqualifications:
3.
Date of incident:
Person involved:
Amount of fine, penalty or disqualification period:
Details of charges, offences, infringements, convictions or disqualifications:
Are there any additional traffic matters to disclose?:	Yes No
If yes provide details of all additional traffic matters.:
Made a claim on any motor insurance policy?:	Yes No
Suffered a loss or damage to a motor vehicle for which you did not claim or were not insured for?:	Yes No
If you have answered “Yes” to either question please describe the circumstances below.
1.
Drivers name:
Person at fault:
Cost ($):
Date of loss:
Insurer:
Details of loss:
2.
Drivers name:
Person at fault:
Cost ($):
Date of loss:
Insurer:
Details of loss:
3.
Drivers name:
Person at fault:
Cost ($):
Date of loss:
Insurer:
Details of loss:
Are there any additional accident/claim matters to disclose?:	Yes No
If yes provide details of all additional accident/claim matters.:
Suffer from any illness or disability, likely to affect driving ability?:	Yes No
If yes, please provide details.:
Had any claims refused, insurance policy declined, cancelled or had special terms imposed?:	Yes No
If yes, please provide details.:
Declared bankrupt and not discharged within the last 12 months, or currently involved in bankruptcy or repossession proceedings?:	Yes No
If yes, please provide details.:
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?:	Yes No
If yes, please provide details.:

Securus Motor Insurance Quotation Form

Broker or dealer details

Period of insurance

The applicant

Overnight address

The cover

Vehicle details

Vehicle Use

All people who will drive your vehicle

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

Important notices

Our Product Disclosure Statement

Duty of Disclosure

Non-disclosure

We provide cover for:

Key Benefits:

Why One Underwriting?

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