1300 INSURE

(1300 467 873)

Motor Vehicle

When you need broad cover at competitive prices, just ask your EBM account manager for advice. Our motor vehicle insurance team will research the most suitable policies for your vehicle type and driving requirements (eg, work or family or both, long distance or city driving, vehicle age etc), and make sure you get exactly the cover you need. If you need to make a claim, our friendly staff will do everything possible to get you back on the road quickly.

If you would like a quote for your Motor Vehicle policy, please complete the below form.  Once submitted one of our brokers will prepare a quotation and be in contact with you.

If you would like a quote for your Commercial Motor Fleet, please contact us via the Quick Contact Form on the right and a broker will be in contact with you.

Privacy

We are committed to protecting your privacy. We use the information you provide to advise about and assist with your insurance and/or financial planning needs. We only provide your information to insurance companies, underwriting agencies, wholesale brokers and premium funders with whom you choose to deal (and their representatives). We do not trade, rent or sell your information. If you don't provide us with full information, we can't properly advise you and you could breach your duty of disclosure. You can check the information we hold about you at any time.

For more information about our Privacy Policy, ask us for a copy or view here. By completing the request below, I certify that I am aware that any collection of personal information is used in accordance with EBM's Privacy Policy.

Contact Person*:

Contact Phone*:

Contact Email*:

Contact Postal Address*:

Name of Registered Owner*:

Driver Details:

Registered Driver*:

Date of Birth*:

% of Use*:

Years Driving*:

At fault claims last 3 years*:

Gender*:

Other Regular Driver:

Date of Birth:

% of Use:

Years Driving*:

At fault claims last 3 years*:

Gender*:

Vehicle Details:

Year*:

Registration No.*:

Make & Model*: (eg: Kia Pregio)

Body Type*: (eg: Sedan or Ute)

Colour*:

Modifications*:

Series:

Transmission*:

Please Select...ManualAutomatic

Use of Vehicle*:

Please Select...PrivateBusiness

Business Description: (eg: courier, carpenter)

Security*: (eg: Alarm, Immobiliser)

Was the car purchased as new                        Please selectYesNo

in the last 12 months?*:

 

If Yes; Year, Value & Purchased from:                 

 

If No, What year was the vehicle purchased?   

 

Suburb where parked at night*:

Type of parking*:

Please Select...Locked GarageCar PortOn StreetOff Street

Type of Cover:

Basis of Settlement:?

Market Value

Market Value means the insurers assessment of the value of your vehicle or other covered property immediately prior to any loss or damage.

Agreed Value

Agreed Value means the amount shown in the policy schedule as your sum insured. Note. Agreed Value is not available on all vehicles.

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Please Select...Agreed ValueMarket Value

Sum Insured:

No Claim Bonus %:

Accessories

Cover Required:

Please Select...ComprehensiveThird Party Only

Finance:

Interested Party*:

Finance Type*:

Optional Benefits:

NCB Protection*: (one at fault claim per year without reduction in NCB)

Please Select...InsuredNot Insured

 

Hire car following an accident*:

Please Select...InsuredNot Insured

Windscreen Protection*: (one windscreen/window claim per year without the application of excess or loss of NCB)

Please Select...InsuredNot Insured

 

Tools of Trade*:

Please Select...InsuredNot Insured

Voluntary Excess:

Is a voluntary excess for reduction in premium to be included in the quote:

Please Select...YesNo

 

If yes, how much?

Please Select...$100$200$500$1,000

Loss History - has the registered owner/insured &/or any driver to be nominated in the policy:

 

1. Has any insurer refused or cancelled cover on any of your policies or required special terms to insure you in the past 12 months?*

Please Select...YesNo

2) Have you, or any person who will drive your car(s), in the past 12 months

a) Been charged with, or convicted of, or penalised for, any motoring offences? (This includes on the spot fines but does not include parking offences)*

Please Select...YesNo

b) Had a driving licence suspended, cancelled or restricted by endorsement?*

Please Select...YesNo

c) Been charged or convicted of any criminal offence?*

Please Select...YesNo

3) Has your car been modified or converted from the Maker's specifications or fitted with accessories other than those supplied as Maker's options?*

Please Select...YesNo

4) Are there any other material facts that you need to tell us? (refer to your policy booklet)*

Please Select...YesNo

If yes to any questions, please give details (including dates and amounts paid or penalty received)

Additional Comments

Preferred Method Of Contact*

Please Select...EmailPhone

* Required Fields