Motor Vehicle Insurance Australia

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Motor Vehicle Insurance - Instant Quote Request

Once you have filled in this form and specified all your information, Sinclair will calculate the most cost effective Motor Vehicle Insurance Quote according to your needs. Filling out this form is not binding nor does it create any obligation to purchase our insurance policy.

All Fields are Mandatory

Starting Date

Your insurance should start on?

(Maximum 28 days in advance.)

Applicant Information

Honorific	First Name	Middle	Last Name

Daytime Phone Number

Evening Phone Number

Fax Number

Email Address

Home Address

Address Line 2

City

Postcode

States and Territories

Insured Name and Address

Please provide the name and address under which the contract of insurance should be issued:

Use the Applicant's name and address

First Name	Middle	Last Name

   Home Address

   Address Line 2

   City

Zip Code

States and Territories

Driver Information

Age of youngest driver:

Number of years youngest driver has an Australian driver's license:

Last claim or accident reported by main drivers:

Last driving offences or traffic infringements by main drivers:

Motor Vehicle Information

1. What type of vehicle do you want to insure?

  Type:

  Year of Manufacture:     Make:

  Transmission Type:     Engine size (in cc):

  Vehicle model: (ex: Ford Escape, Ba, Xls Summer, Wagon)

  Registration number:

  VIN/Chassis number:

2. Does your vehicle have any non-standard accessories?
No    Yes
If you answered yes, please detail the values of the accessories:

3. Does your vehicle have manufacturer optional accessories?
No    Yes
If you answered yes, please provide complete details:

4. Does your vehicle have metallic paint?
No    Yes

5. Has your vehicle been modified in any of the following ways: engine, body/paint, suspension or wheels?
No    Yes
If you answered yes, please detail the modification(s) made in your motor vehicle, and their value:

6. Do you have any operational security devices fitted to you vehicle?

7. How is your vehicle financed?

If your car is financed, please enter the name and address of your financial institution:

8. What is the principal use of the vehicle?

Additional Options

9. For an additional fee you can increase your level of cover by selecting any of the following policy options.

9a. Would you like to add our rental car following an accident option?	No Yes
9b. Would you like to reduce the excess for windscreen claims to $40 only?	No Yes
9c. Would you like to increase the basic excess?	No Yes by 50% Yes by 100%

The policy will subject to the following excesses (deductibles), unless you choose to increase the basic excess above: A basic excess of $450 for all drivers
Additional age excess for drivers under 21 years of age: $900
Additional age excess for drivers under 25 years of age: $450
Additional age excess for drivers 25 years of age and over with no more than 3 years driving experience: $450

Thank you for filling out the Motor Vehicle Request a Quote Form. Please submit the form by clicking on the "Submit" button below, your personal quote will be processed and shown on the screen right away.

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Sinclair Insurance Company Ltd., by N.M. SIM Management Ltd, Authorized Representatives - ABN 13267191473
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