Truck Insurance Proposal Form

Do you have an existing business?*

Yes

If Existing Business

Number of years business in operation*

Current Insurance Company Name*

Current Policy Expiry date*

Any motor claim history in last 5 years*

Yes

Insured Details

Name*

ABN*

Business Address*

Postal Address*

Phone Number*

Email*

Contact Person*

Director/ Owner

Director/Driver Name*

Date of Birth*

Licence Type and Year Licence Obtained*

Driving Experience*

Truck Details

Registration Number*

State of Registration*

Year*

Truck: Make & Model*

Truck: Body Type*

Truck: Payload Or GVM*

Refrigerated?*

Yes

VIN*

Engine No.*

Transmission Type*

Auto

Manual

Sum Insured Required*

What you carry?*

No. of claims on this vehicle*

DG Sum Insured Required*

Registered Owner*

Trailer In Control (TIC) Reqd:*

Yes

TIC Sum Insured (Truck)*

Garage Postcode*

Radius (in Kms)*

Any Loan?*

Yes

Interested Party Name*

Add more

Truck Insurance Proposal Form

If Existing Business

Insured Details

Director/ Owner

Policy

Duty Of Disclosure

If Existing Business

Insured Details

Director/ Owner

Policy

Duty Of Disclosure

If Existing Business

Insured Details

Director/ Owner

Policy

Duty Of Disclosure

Truck Insurance Proposal Form

If Existing Business

Insured Details

Director/ Owner

Policy

Duty Of Disclosure

If Existing Business

Insured Details

Director/ Owner

Policy

Duty Of Disclosure

If Existing Business

Insured Details

Director/ Owner

Policy

Duty Of Disclosure

This questionnaire should be completed in conjunction with the ISP Proposal Form. When completed, please sign this questionnaire where indicated, ensuring that prior to signing you have read and understand Your Duty of Disclosure and our Privacy statement.

Section A: General Information

Section B: Machines to be insured

The age of the pumping unit must be supplied

Truck

Pump

Section C: Maintenance And Accreditation

Who undertakes maintenance / servicing of concrete pumping machines?

Section D: Claims and/or circumstances

Who undertakes maintenance / servicing of concrete pumping machines?

Your duty of disclosure

QBE Privacy

UAA Privacy

Declaration

General Information