Motor Insurance Form
Your Details
Full name: (incl Title)
*
Date of birth:
Contact telephone number:
*
Email address:
*
Vehicle Details
Home address:
*
Postcode:
*
How garaged:
Please select
Garage
Car Park
Driveway
Street
Year of vehicle:
Vehicle description:
Sum Insured:
Vehicle use:
Please select
Private
Business
Private Use (Business Registered)
Security
Please tick the security questions that apply to you:
Standard Manufacturer Specifications
Alarm
Immobiliser
Tracking Device
Microdotting
Finance Type:
Please select
No finance
Secured loan
Unsecured loan
Leased
Hire purchase
No Claims Bonus:
Date of birth of most regular driver:
Any regular drivers under 25 who do not own their own car:
Yes
No
If yes - Date of birth:
Please provide full details of any claims made and/or losses suffered under a similar Motor Insurance policy during the past 5 years (whether or not a claim was made):
*
If none, please state
Please use this box to provide any further information that may be relevant to your Motor Insurance policy:
Current Motor Insurance provider:
*
If none, please state
Current Motor Insurance premium:
*
If none, please state
Renewal date of existing insurance / date cover to start (as applicable):
*
NB: Cover is not in force until agreed upon by the company
Contacting You
Are you an existing Trades Essentials customer?
*
yes
no
Preferred contact method:
*
Please select
Telephone
Email
Letter
Preferred contact time:
Please select
No preference
08:00-10:00
10:00-12:00
12:00-14:00
14:00-16:00
16:00-18:00
How did you hear about us?
*
Please select
Referred by friend
Referred by another business
Referred by another website
Search engine
Advertising
Trades Essentials is a trading name of Bourchier Nominees Pty Ltd. We would like to contact you from time to time about products and services (or with news, offers, and promotions) that we feel may be of interest to you. By providing us with your contact details, you consent to being contacted by these methods for these purposes.
Please tick the box if you prefer to
not
receive marketing communications from us by post or telephone.
Please tick the box if you prefer to
not
receive marketing communications from us by email, text messaging or other electronic means.