Freeman Mcmurrick Quotation & Proposal Securus Motor Insurance Page 3
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7Finance
Yes
No
If yes, finance type and name of provider.
Finance type
Please select...
Amount owing (if Hire Purchase or Loan, if leased the unexpired term left.)
Has the vehicle been uninsured during the last 30 days?
Yes
No
If yes, please provide details why not.
Are you entitled to a No Claim Bonus or Discount?
Yes
No
(Copy required to be attached to this application for insurance.)
No Claim Bonus
Nil
10%
20%
30%
40%
50%
60%
60% Rating 1 Protected
Insurer name
Policy number
Vehicle use
What purpose will you use your vehicle?
Private
Wedding hire
Other
Business use, please describe
How often is your vehicle driven?
Regularly (more than twice per week)
Once or twice a week (limited use/ <6,000km pa)
Once a month or less (extreme limited/ <3,000km pa)
Never (on site cover only)
Is the vehicle in good repair (except if you want Laid Up Cover)?
Yes
No
Has the vehicle been recently registered?
Yes
No
Do you use your vehicle to commute to and from work?
Yes
No
Where is the vehicle parked overnight?
Locked garage
Unlocked garage
Driveway
Car park
On street
Carport
Other
Street
Suburb
City
State
Postcode
Where is the vehicle parked during the day?
Locked garage
Unlocked garage
Driveway
Car park
On street
Carport
Other
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Parent category: Business