On-line Transport Operators Insurance


Thank you for considering our on-line transport operators 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 transport operators 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.


Details of Under 25 and Over 80 Year Old Drivers:
1.
You must advise details on all drivers under the age of 25 or over the age of 80 who will drive any of the vehicles to be insured:
Driver's full name(s)
Surname Given name(s) Date of birth Advise registration number of all vehicles these drivers will drive
Please note: Drivers under 25 in relation to Prime Movers and drivers under 21 in relation to rigid vehicles with a GVM greater than 12,000kg (8 Tonne) are excluded from coverage.
Previous Experience:
In the last 5 years have you or any other person likely to drive the vehicles:
2. Had:
a. a claim, accident or car stolen or burnt (even if not reported or not claimed from an insurer)?
Yes No
b. insurance refused, declined or cancelled by an insurer or any special conditions imposed?
Yes No
c. a drivers or motorcycle licence cancelled, suspended or endorsed?
Yes No
3. Been convicted or charged with:
a. drug use, driving under the influence, or exceeding prescribed concentration of alcohol?
Yes No
b. any driving offences or speeding infringements (other than parking offences)?
Yes No
c. fraud, arson, theft or any other criminal act?
Yes No
4. Suffered from any physical or mental disability (excluding wearing of glasses/lenses)?
Yes No
If you answered Yes to any other above questions, please provide details below:
Name of driver Date of incident Details of each incident or act Your Insurer Person at fault
5. Have you or any other person likely to drive these vehicles ever had a penalty imposed by a regulatory authority in relation to Transport Operations?
Yes No
If Yes, please provide details below:
Name of person penalty awarded against Cost ($) Date of incident Details of incident What have you done to prevent recurrence that gave rise to the penalty?
6. Is this a new venture or have you been trading for less than two (2) years?
Yes No
If Yes, please provide details below:
Date Venture Commenced Details of experience prior to new venture
Vehicles (If insufficient space, please attach a document with the relevant information):
7. Commercial Motor Vehicle - Details to be completed for all vehicles
  Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5
a. Type of Cover: Comprehensive (Comp) or Third Party Property Damage (TPPD)
b. Make of vehicle e.g. Ford, Holden, Isuzu, Mack, Freightliner etc.
c. Model or type e.g. Hino, FF177, Isuzu, NPR etc.
d. Year of Manufacture
e. Body style e.g. van, pantech, tray, rigid, articulated etc.
f. Registration number
g. Engine or VIN number
h. Accessories: Please list all accessories fitted to the vehicle that are non standard e.g. Bull bars, air conditioning.
i. Your estimate of the Vehicle's 'Market Value' including accessories ($)
j. If the vehicle has been 'modified', please advise details e.g. lowered, supercharged etc.
k. If the vehicle is financed, please advise the type of finance e.g. lease, hire purchase, secured or unsecured bank loan
l. Name and address of financier
m. Date of purchase of vehicle
n. Price paid for the vehicle (excluding any trade-in or consumer credit insurance) ($)
o. If the vehicle is imported, has it an Australian Compliance Plate?
Yes No
Yes No
Yes No
Yes No
Yes No
p. Has the vehicle any existing damage e.g. dents, scratches, rust or hail?
Yes No
Yes No
Yes No
Yes No
Yes No
  If Yes, please give details
q. No Claim Discount entitlement (Confirmation of NCD must accompany the proposal)(%)
r. Name of the main driver
s. Date of birth of main driver
t. Licence number of main driver
u. Class of licence of main driver
v. No. of years this licence held by main driver
w. Postcode where vehicle is parked at night
x. How parked? e.g. in the street, garaged, etc.
y. Goods carried
z. Gross vehicle mass (kg)
aa. Occupation e.g. general freight carrier, sand and soil carrier, etc.
bb. Nature of work undertaken
cc. Radius of operations: Vehicles over 3,500 kg gross vehicle mass are limited to 250km radius unless radius increase is selected. (km)
dd. Maximum speed of vehicle (km/h)
8. Marine Carriers
a. Is cover required? (if selected, cover applies to all good carrying vehicles excluding trailers)
Yes No
Yes No
Yes No
Yes No
Yes No
b. Limit per vehicle $500,000, $750,000, $1,000,000, $2,000,000 ($)
c. Limit per location $500,000, $750,000, $1,000,000, $2,000,000 ($)
d. Do you enter into contractual agreements?
Yes No
Yes No
Yes No
Yes No
Yes No
  If Yes, please name the principal contractors(s)
9. Liability
a. Is cover required? (if selected, cover applies to all good carrying vehicles excluding trailers)
Yes No
Yes No
Yes No
Yes No
Yes No
Basis of Settlement:
For all vehicles the Basis of Settlement will be at our option to repair, reinstate or pay the amount of the loss of or damage to your vehicle plus standard accessories and those included on the schedule provided such payment does not exceed the market value at the time of the loss but limited to the amount shown on the Schedule for each vehicle.


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:
ABN:
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:
Country: