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Home
About
About Us
Affiliations
Steadfast
Testimonials & Partners
Why Use PCIB?
Products
Resources
Home and Contents Quote
Landlord Quote Request
Motor Vehicle Quote
Notify a Claim
Pay my Invoice
Important Documents
Request an Insurance Quote
Sum Insured Calculators
Travel Insurance Quotes
News
Contact
Motor Vehicle Quote
Step
1
of
5
- Personal information
20%
Hi, let's get some details for your vehicle quote.
Contact Name
*
First
Last
Email
*
Phone No
*
Tell us about Driver details.
Name of Registered Owner
*
Tell us about Vehicle details.
Vehicle Year/Make/Model
*
Accessories
Modifications
Transmission
*
Type of Cover Requested
*
Comprehensive (Unlimited kms)
Comprehensive ‘Limited Kilometres’ (Limited to 5,001-8,000 kms per year)
Comprehensive ‘Low Kilometres’ (Limited to 0 – 5,000 kms per year)
Agreed Value
*
If Purchased in Last 12 months
Purchase Price
Purchase Date
DD slash MM slash YYYY
No Claim Bonus or Rating No
*
No Claim Bonus or Rating No
60%/Rating 1
50%/Rating 2
40%/Rating 3
30%/Rating 4
20%/Rating 5
0%/Rating 6
Tell us more details about your vehicle.
Use of Vehicle
*
Occupation
*
Finance
*
Yes
No
Financier
*
Address where vehicle is left overnight
*
Street Address
Parked overnight in
*
If Other
*
Security Device Fitted?
*
Yes
No
If yes, details of immobiliser or tracking system
*
Drivers Details
*
First Name
Last Name
% of Use
Date of Birth (dd/mm/yyy)
Please ensure % of Use totals to 100% across all drivers.
1. Drivers less than 25 years of age not acceptable (30 in some cases).
2. Approved drivers must be licensed in Australia or New Zealand (provisional licenses excluded).
In the LAST THREE (3) YEARS have any of the drivers had any accidents, vehicles stolen or burnt, or any other losses involving a vehicle where an insurance claim has been made?
*
Yes
No
Please provide details
*
Driver Name
Description of Loss
Date of Loss
Cost of Loss
In the LAST THREE (3) YEARS have any of the drivers committed any traffic offences which have resulted in a conviction or for which a penalty has been imposed or points lost?
*
Yes
No
Please provide details:
*
Driver Name
Description of Offence
Date
Penalty Imposed
If Speeding, kms over limit
Thanks for your details, please confirm you are not a robot and we'll get onto your quote request straight away. We'll make contacts directly to you via email.
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