Main Menu     Quotations    Motor Hotline    Send Email     Contact Us 

 Brokers National 

Brokers National Classic / Veteran Car cover can be insured Comprehensively or Laid Up cover                                                 Simply Answer The Questions Below                                 Sometimes The Insurer May Ask For A Photo Of Your Motor Vehicle              

EMAIL Or FAX: 

On-Line Classic / Veteran Car Insurance Quote


Thank you for considering our on-line classic / veteran car insurance quote service. Brokers National has accounts with most insurers and underwriting agencies. We aim to find you the best car insurance deal possible.

Please fill in the following form - answering all questions, then either:

1. Click on "Email to Brokers National" at the bottom of this form.  OR                               

2. Highlight this form to "Print It" and then "Fax It" to our office on 03 9791 6633.


 Use the Mouse or the Tab key to move to the next field. We will respond with quotes as soon as they have been received from our insurers.

Motor car insurance select policy type:
(please select from list):

Policy options:
Would you like to pay extra to include windscreen replacement ?:
(which doesn't affect your No Claim Bonus)		 Yes      No
Would you like to pay extra to include No Claim Bonus protection?:
(You retain your NCB even if you have an accident which is your fault)		 Yes      No
If you are over 25 would you like to exclude drivers under 25 from using this vehicle? Yes      No
If you are over 25 would you like to limit drivers to 2 named drivers only? Yes      No

About the vehicle you wish to insure:
Make Of Vehicle:
Vehicle Model:
(e.g. Commodore)
Type Of Vehicle:
Series:
(e.g. VT)
Year Of Manufacture:
Body Type:
Engine capacity: litres
Turbo: Yes      No
Transmission: Manual     Automatic
Metallic paint:
List Accessories / modifications (please give details and value):

Estimated value of vehicle: $ Including Accessories
Is the vehicle a private import?   Yes    No
Suburb where the vehicle is parked at night:   Postcode:
How will it be parked?
Suburb where the vehicle is parked during the day:   Postcode:
How will it be parked?
Is Laid Up cover required during Restoration? Yes    No

 
How often is the car used?:
Approximate distance travelled per year:  kms
What purpose is the vehicle mainly used for?
What is the ownership status of the vehicle?
Do you have any car club memberships?
(give details):

Security information about the vehicle:

Does the vehicle have any anti-theft equipment? Yes    No
If yes, please specify: Audible alarm only
Alarm & engine immobiliser (2 point)
Lock tight deadlocking
Steering lock
Mobile tracking
Self arming passive immobiliser (3 point)
Ignition kill switch
Other (please specify)  

Driver information:

Date of birth of main driver:

 M:    F: Percentage of use: %
Occupation of main driver:  
How long has this driver held a drivers licence? years
Have you had any traffic offences, accidents, vehicles stolen, any other vehicle loss/damage and licence suspension or cancellation for the last 5 years? Yes      No
If yes please give full details:

Are you entitled to a No Claim Bonus with your current insurer? Yes     No
If yes, please specify what rating:
If you hold rating 1, how many years has it been since your last claim
(enter 99 if you have never claimed):

List Below ALL Drivers Under 25 Years That May Drive This Vehicle At Anytime?
Date of birth of other driver: M:    F: Percentage of use: %
Occupation of other driver:  Does Driver  Own A Vehicle Yes   No
Date of birth of other driver: M:    F: Percentage of use: %
Occupation of other driver:  Does Driver  Own A Vehicle Yes  No

Insurance history of the vehicle:
Your Current Insurer:            Your Policy Due Date:  
Any other notes you wish to include:
 

Contacting you about your quote:

Please make sure you leave a contact phone number and the best time to call you.
Your Name:
Company name:
Your Phone Number & Area Code:
Best Time(s) To Call:
Please send my quote by (select at least one): email     phone     fax     mail
Your Email:
Your Facsimile:
Your Postal Address:

Click On Email Quote To Send Form To Us
 

Main Menu     Quotations    Motor Hotline    Send Email     Contact Us