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Novated Lease Insurance Application

Looking to use our recommended Insurance Provider for your Car? Complete this Insurance Application to get the process rolling.

Please note that your information is saved on our server as you enter it & may be resumed at a later time if needed.

Need to Talk to Someone First?
1
Registered Owner
2
Driver(s) Details
3
Vehicle Security
4
Owner/Driver History
5
Declaration
Step 0 / 3
The Registered Owner of the Car
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Registered Owner
2
Driver(s) Details
3
Vehicle Security
4
Owner/Driver History
5
Declaration
Step 0 / 3
Covered Driver(s)
Delete
Add another covered driver (maximum of 5)
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Registered Owner
1
Driver(s) Details
3
Vehicle Security
4
Owner/Driver History
5
Declaration
Step 0 / 3
Vehicle Security
Does the vehicle have any of the following added aftermarket?
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Registered Owner
1
Driver(s) Details
1
Vehicle Details
4
Owner/Driver History
5
Declaration
Step 0 / 3
Owner & Driver(s) History
In the last 5 years, have you (or any person likely to drive the car):
Claim/Accident(s) | Details Required:
$
Delete
Add another claim/accident (maximum of 5)
Insurance Incident | Details Required:
Licence Cancelled/Suspended/Endorsed | Details Required:
Substance Conviction | Details Required:
Traffic Infringement(s) | Details Required:
Delete
Add another infringement
Criminal Conviction | Details Required:
Disability | Details Required:
In the last 12 months, have you:
Prior Insurance | Details Required:
1
Registered Owner
1
Driver(s) Details
1
Vehicle Details
1
Owner/Driver History
5
Declaration
Step 0 / 5
Declaration
In submitting this form, I,
<first-name>
 
<last-name>
:

Please be advised that the initial approval of this application is based on the information provided, and if additional information is required, you may be contacted by the Fleet Manager.

PLEASE NOTE:

This application and any quote given are subject to full assessment on all the information provided by the applicant and are indicative to full assessment by the Insurer. Any failure to provide the correct information may give the Insurer the right to deny any claim.

Your Duty to take Reasonable Care not to Misrepresent:

You have a duty to take reasonable care not to make any misrepresentation when entering into, varying, extending or renewing the Policy.

This means that it is essential that You respond to specific questions that We ask honestly and to the best of your knowledge, including where We ask You to confirm or update information that You have previously given to US when entering into, varying, extending or renewing the Policy.

To assist You with providing Us with honest and accurate responses to any questions We ask of You, We have endeavoured to ensure that any question We ask are clear and easy to understand.

Further, where possible, We have also included examples of the types of responses We are looking for when asking a particular question.

If You are unclear of any particular question or would like us to explain it to you, please get in touch with us and we will explain this to you.In determining whether You have fulfilled this duty to take reasonable care not to make a misrepresentation to Us, We will consider all of the relevant circumstances of a particular case.  

If You do not respond honestly and accurately to specific questions that We ask, We may (acting reasonably) cancel Your contract or reduce the amount We will pay You if You make a claim, or both.  It is therefore vital that you be honest and specific in Your responses.  If Your failure to tell Us is fraudulent, We will refuse to pay a claim and treat the Policy as if it never existed (this does not mean that We will refund any premiums that You have already paid).

ADDITIONAL INFORMATION

Should there not be enough room to provide your answers to the questions herein, please provide your response in a separate document attaching and forming part of this application for insurance

Privacy Act 1988:

The Fleet manager is committed to protecting your privacy and the confidentially and security of personal information provided by you to us. We are therefore bound by the National Privacy Principles and the Privacy Act 1988 (Cth).

Information we collect:

All the information that we ask for is required for us to effectively coordinate your vehicle insurance and to provide you with the benefits available to you as part of the Fleet Manager service package.

Right of access:

You have the right to access any such information held by the Fleet Manager that relates to you and to collect any information that is inaccurate. If you object to us using the information as described you can advise us at any time in writing.

Permission:

I give express permission to receive Product Disclosure Statements and/or other relevant documentation electronically.

Thank you, <Name>!
Your Insurance Application has been successfully received.
What happens next?
1-2 business hours
1. We review your insurance request
We will review these details and send them across to the Insurance Underwriter if all looks good
2-6 business hours
2. Outcome of Application
We will hear if the underwriting has been confirmed and accepted, and get back to you on the outcome.
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