Limousine and Hire Car Insurance

Thank you for considering our on-line limousine and hire car insurance service.   Because Greater National Group is an insurance broker, not an insurance company, we will process your application with major insurance companies in order to find the right limousine and hire car insurance for you.

Please fill in the following form as fully as possible, then click 'submit' at the end of the form.
You can use the TAB key to move to the next field. We will respond with your terms as soon as we have researched the market for the right available deals that fit your requirements.

1. Make of the vehicle:
2. Model of the vehicle:
3. Manufacture year of the vehicle:
4. Body Type:
5. Reg. Number:
6. Vehicle is:
7. Transmission Type:
Automatic Manual
8. Is the vehicle modified?
Yes No
If yes, please provide details:
9. Security Installed:
Alarm/Immobiliser Factory Anti-Theft Immobiliser
Tracking System Alarm No Security
10. Do you want insurance for the market value?
Yes No
If No, please provide the sum insured required: $
11. No Claim Bonus Entitlement? %
12. Rating Number:
13a. Suburb and Postcode where parked at night:
13b. Where is the vehicle parked overnight?
Garage Carport Driveway Street Other
If Other, please provide details:
14a. Suburb and Postcode where parked during the day:
14b. Where is the vehicle parked during the day?
Garage Carport Driveway Street Other
If Other, please provide details:
15. Current Insurer:
16. Finance?
Yes No
If Yes, please provide the financier name:
17a. Was the vehicle purchased in Australia?
Yes No
17b. Purchase Date:
18. Usage?
Daily Weekly Monthly Other
If Other, please provide details:
19. All Driver Details
Full Name Date of Birth Full Occupation % of use
20. Have any Drivers above had any accidents or claims in the last 5 years?
Yes No
If yes, please give full details:
21. Have any Drivers listed above had any driving offences, resulting in conviction or loss of licence or demerit points?
Yes No
If yes, please give full details:

Duty of Disclosure:
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?
Yes No
If so, please provide details:
I/We hereby declare that:
My/Our attention has been drawn to the Important Notices accompanying this form and further I/we have read these notices carefully and acknowledge my/our understanding of their content. The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter between the date of this form and the inception date of the insurance to which this relates I/we shall give immediate notice thereof. I/We authorise GNG and the Insurer to collect or disclose any personal information about another individual (for example, an employee, or client), I/we declare that the individual has been or will be made aware of that fact and the Privacy Policy. I/We also confirm that I/we am/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this form and I/we complete this form on their behalf.
Any other comments, requests or relevant information you need to add:
Contacting you about your quote:
In order to select the most appropriate cover for you, it may be important to discuss quote details in person. Please leave a contact phone number and best time to call to facilitate this.
Your full name:
Company/Business/Name of Applicant to be Insured:
Your phone number (please include area code):
Your mobile phone number:
Best time(s) to call:
Please send my quote by (select at least one):
email phone fax mail
Your email address:
Your website address:
Your fax number:
Your postal address: