Request A Quote Form

Please fill in the details below and we will get back to you shortly. Fields marked with * are compulsory.

Type of Vehicle Use



Personal Details

Person who will be the policy owner and named on the certificate of insurance.


Are you the registered owner?



Vehicle Details



Is the vehicle fitted with an alarm and immobiliser NZSA 3 star or better rated?




Does your vehicle have any stereo equipment, alloy wheels, or other accessories fitted to the car that you wish to insure as separate items?




Do you have or have you had car insurance in the last 2 years?


Drivers





















Club Auto policies only cover those people who have been named as drivers.


Has anyone driving this vehicle ever had any insurance declined, cancelled or been refused renewal, or had special terms or extra premium imposed?


Has anyone driving this vehicle ever had any insurance Claims declined?


Do you or anyone else who will drive this vehicle have any or have had a history of vision or hearing impairments, any physical or mental infirmity, fits of any kind, diabetes or any other medical condition that may affect their driving ability?