Vehicle Details
Has the vehicle been modified in any way from the vehicle manufacturers specifications, such as exhaust, lowering, engine modifications etc.
Is the vehicle: V8/V10/V12, Turbo, Supercharged, Rotary, Electric?
Are there any stereo equipment, alloy wheels, or other accessories worth more than $1,000.00 fitted to this vehicle that you wish to insure as separate items?
Details and market value of item/s:
Is the vehicle fitted with a working alarm and or immobiliser? If "Yes" what type? e.g. "factory fitted"?
Does the vehicle have any un-repaired or pre-existing damage – including mechanical?
What is the parking situation? E.g. Garage, driveway, street etc.
What options would you like to include with your quote?
Vehicle Owner's Details
Do you have or have you had car insurance in the last 2 years?
Does this driver hold a Passenger Endorsement on their license?
Club Auto policies only cover those people who have been named as drivers.
Disclosure
In the last five years have you or any of the other drivers:
Had any accidents, damage, or theft, whether a claim was made or not (regardless of fault)?
Had a driver license endorsed, suspended, cancelled or disqualified?
Been charged with, convicted of, or committed any driving or vehicle related offences (excluding parking)?
Had motor vehicle insurance denied, cancelled, refused or special terms imposed?
Had any insurance claim declined?
Been convicted of or committed any criminal offence (other than traffic or parking offences), have prosecutions or convictions pending, or been bankrupt or undergone a No Assets Procedure in the last 10 years (Subject to the Criminal Records (Clean Slate) Act 2004)?
Is there any other information that may be relevant to our assessment of your insurance quote request e.g vehicle finance
Privacy Information
Information that you supply to us (including personal information) may be held and used by Club Auto Insurance (NZ) Limited and our nominated Binding Insurer, TOWER Insurance for the purpose of providing you with insurance quotes. Any personal information that you provide Club Auto will be collected and held by Club Auto and our nominated Binding Insurer. The Privacy Act entitles you to have access to, and request correction of, this information which you may do by contacting us on 0800 506 506 or emailing sales@clubauto.co.nz. Failure by you to provide accurate and complete information may result in your application for insurance being declined, your claim being reduced or declined, or we may void your policy from the outset. If anything changes, you must tell us. Where you provide us with personal information about any other person to enable us to underwrite your insurance, you confirm that you have the authority from those people to disclose such information. Any quote you receive from Club Auto Insurance has been based on information that you have supplied, this is given as INFORMATION ONLY. You should always seek your own financial advice prior to accepting any insurance policy. You may view Club Auto's policy wordings on our website at any time prior to making YOUR decision.
