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Obtain a Motor Insurance Quote

Date
DD slash MM slash YYYY
Commence From
MM slash DD slash YYYY
Client Name
D.O.B
DD slash MM slash YYYY
Client Name 2
D.O.B
DD slash MM slash YYYY
Address
Street Address Address Line 2 City State Post Code
Phone
Email*
Drivers Licence
Type
- Third Party
- Comprehensive
- Fire & Theft
Vehicle Usage
- Private
- Business
Make
Year
Model
Transmission Type
- Auto
- Manual
Agreed Value
Registration
Vehicle Type
- Sedan
- Ute
- Van
- 3 Door Hatch
- 5 Door Hatch
Cylinders
- 4
- 6
- 8
- Turbo
Engine
- Petrol
- Diesel
Optional Features
- Metallic Paint
- Sunroof
- Leather
- Other
Parking
- Garage
- Carport
- Driveway
- Street
Security
- None
- Alarm
- Immobilizer
- Kill Switch
Claims History
Finance
- Yes
- No
Finance Company
Hire Car
- Yes
- No
Windscreen
- Yes
- No
Listed Driver
- Yes
- No
60% No claims bonus
- Yes
- No
Current Insurer
Amount
Related Documents
Drop files here or

Max. file size: 8 MB, Max. files: 2.
If you would like to send the Claims team any documentation or photos in support of your claim, you may do so by selecting a maximum of 2 files that will be sent with the information above.
Current Policy Expiry Date
DD slash MM slash YYYY
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Email
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Contact

PO Box 333 WELLAND SA 5007

08 8244 9999
(For local callers)

1300 660 191
(Interstate local call cost only)

Online Claims
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