Full Name ABN Email Address Mobile Number 1. How many vehicle/s are you looking to insure? 12-1011+ 2. Is your vehicle/s fitted with dashcams? YesNoSome vehicles yes/Some vehicles No 3. Does your vehicle/s have reverse cameras or object sound warnings? YesNoSome vehicles yes/Some vehicles No 4. Does your vehicle(s)have lane departure warning systems? YesNoSome vehicles yes/Some vehicles No 5. Does your vehicle(s) have handsfree and/or blue tooth connection capabilities for communication devices? YesNoSome vehicles yes/Some vehicles No 6. Do you currently use a Telematics data logger in your vehicle(s)? (Other than a basic GPS tracker) YesNoSome vehicles yes/Some vehicles No 7. Is your vehicle(s) subject to finance? YesNoSome vehicles yes/Some vehicles No 8. Is the vehicle(s) parked in a garage, driveway, carport or street parking? GarageDriveway ParkingStreet ParkingCarport 9. How long have the driver/s engaged by the operator held their drivers license in Australia? 2 years2-5 years5 years + 10. Have any of the drivers incurred any demerit points in the last 3 years? YesNo 11. Have any of the drivers have had an at fault claim in the last 3 years? YesNo 12. In the last 3 years, have any of the drivers had any insurance declined, cancelled or refused? YesNo 13. In the last 3 years, have any of the drivers listed in this application been charged or convicted with a criminal offence? YesNo 14. In the last 3 years, have any of the drivers listed in this application had a denial of an insurance claim due to fraud or dishonesty? YesNo 15. Do you have a rental agreement in place with your drivers for a minimum period of 3 months? YesNo 16. How often are driver licenses checked? Once a yearMore than once a yearNever 17. Do you have a claims experience report on an insurer letterhead for the vehicle/s you are looking to insure? YesNo Drivers License Rego Papers Rental Agreement