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                                            Prestige Motor

Brokers National Looks Forward To Obtaining Insurance Prestige Motor Quotations For You                                                   We Appreciate The Opportunity To Assist You                                       Did You Know We Also Help You If A Claim Occurs                                      Please Contact Our Office If You Have Any Questions                                       Thank You

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On-Line Prestige Motor Car Insurance Quote


 Thank you for considering our on-line prestige motor insurance quote service. Brokers National has accounts with most insurers and underwriting agencies. We aim to find you the best motor 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.

Prestige Motor Insurance

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

Policy options:

Would you like to pay extra to include one windscreen claim per year?:
(which doesn't affect your No Claim Bonus)
  Would you like to include No Claim Bonus Rating 1 Protection?:
( retain your NCB even if you have an accident which is your fault)
Would you like to exclude drivers under 25 from using this vehicle?
Would you like to restrict drivers to 2 named people only?

About the vehicle you wish to insure:
Make Of Vehicle:
Vehicle Model:
(e.g. Falcon, Camry, Commodore etc.)
Type Of Vehicle: (e.g. GL, GLX, etc.)
Series: (e.g. FJ, VC, VT, VXi etc.)
Year Vehicle Manufactured:
Body type (Sedan, Wagon etc.):
Engine capacity in litres:
Turbo:
Transmission: Manual     Automatic
4 Wheel Drive:
Accessories / modifications (please give details and value):
Estimated value of vehicle: $
Suburb vehicle will be parked at night:   Postcode:
Where will it be parked?
Suburb vehicle will be parked during the day:   Postcode:
Where will it be parked?
   
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?


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 The Driver  Own A Vehicle Yes   No
Date of birth of other driver: M:    F: Percentage of use: %
Occupation of other driver: Does The 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:
In order to select the most appropriate cover for you, it will be important to discuss the details of the quotes in person. Please make sure you leave a contact phone number and best time to call to facilitate this.


Your name:
Your company name:
Your phone number (please include area code):
Best time(s) to call:
Please send my quote by (select at least one): email    phone    fax    mail
Your email:
Your fax number:
Your postal address:

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