Truck Insurance Quote Please fill in the following details and we will be in contact with you shortly. Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Last Email* Company*Phone*Disclosure QuestionsYears Business EstablishedNew Venture1 year2 years3 years4 years5+ yearsNumber of year's experience in the Transport Industry01 year2 years3 years4 years5 - 10 years10+ yearsNumber of years continuously insured?01 year2 years3 years4 years5+ yearsExpiry Date/Renewal Date of y our current policy? Name of Current Insurer?ZurichCGUQBEUAACMACNTIGlobalAllianzLumleyVeroOtherNot InsuredHave you made any claims over the last 5 years? If so, how many?NoneOneTwoThreeFourFive or MoreHave you had any criminal convictions in the last 10 years?YesNoHave you had any policies cancelled/declined or special terms imposed?YesNoTo the best of your knowledge have you or any drivers reported any of the following driving convictions in the last 5 years?NoDUISuspended licenseMore than 3 speeding finesMore than 3 minor traffic finesInsurance CoverageCommercial Motor InsuranceOwner/Driver age Truck DetailsYearCarry capacityU2Ton2-5T5-10T>10TMakeWill You Be Dry Hiring Your Vehicle?YesNoModelWhat are you carting/carrying?SandSoilGravelMachinery & EquipmentConcrete PumpsMixersAgitatorsTow TruckHazardous GoodsWasteLivestockRefrigerated GoodsLogging LumberGrainSeedContainersGeneral Non Hazardous (if not listed above)Prime Mover/RigidHome Base of OperationSum InsuredWill there be any other drivers?YesNoRegRadius use250km400km1200kmAust WideSerial/ChasDo you require Public Liability insurance?YesNoDo you require Goods in Transit Insurance?YesNoDo you require trailer insurance?YesNoAre you the owner of the trailer?YesNoPublic Liability InsuranceSum Insured Required$10mil$20mil$50milPlease advice Gross TurnoverPlease advise total number of employees/drivers engaged in the business?123456-1010+Goods in Transit InsuranceLimit any one Load/Conveyance required$50k$100k$250k$500k$1MilTrailer InsuranceTrailer yearTrailer - Sum InsuredTrailer modelTrailer TypeTipperFlat TopPlantRefrigeratedLivestockDollyCar carrierFurnitureLow loaderTankerOtherPlease specify the type of trailerTrailer RegistrationCommentsThis field is for validation purposes and should be left unchanged.
