Motor Insurance Quote - Aushine Insurance

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汽车保险 | Motor Vehicle Insurance

开始申请
车牌号码
Vehicle Registration Number
是否登记在公司名下？*
Is the vehicle registered under a company ?
- 是 / Yes
- 否 / No
公司名称*
Company Name
车辆登记持有人*
Insured Name
姓 Last Name 名 First Name
保单生效日期*
Inception Date
DD slash MM slash YYYY

保存表格，稍后继续 / Save and Continue Later

投保内容
投保类型 (可多选）*
Type of Cover
- 综合车险 Comprehensive
- 第三方财产损失车险 Third Party only
投保价值*
Value
约定投保价值*
Sum Insured Required
附加选项
Optional Covers
- 挡风玻璃险 Excess Free Windscreen Cover
- 事故后租车服务 Car Rental following an accident

保存表格，稍后继续 / Save and Continue Later

车辆详情
车辆详情*
Vehicle Details
年份 Year Made 品牌 Brand 型号 Model
主要用途*
Use
业务范围描述*
Description of Business Activities
停放地址*
Overnight Parking Address

街道 Street 区 Suburb 州 State 邮编 Postcode
车辆是否有附加配件或曾被改装需要申报？*
Does the vehicle has additional accessories or any modifications ?
- 是 / Yes
- 否 / No
零件名称 / Accessories 描述 / Description 价值（$）/ Value（$）
车辆是否有贷款？*
Is the vehicle under finance ?
- 是 / Yes
- 否 / No
贷款公司或银行名称*
Name of the Bank, Company or Institution
车辆是否有冰雹造成的损坏？*
Does the vehicle have any existing hail damage ?
- 是 / Yes
- 否 / No

保存表格，稍后继续 / Save and Continue Later

驾驶者信息
驾驶者1*
Driver 1
姓 Last Name 名 First Name
性别*
Gender
驾照签发年份*
Year Licensed
出生日期*
DOB
DD slash MM slash YYYY
过往5年内是否有事故索赔记录？*
Are there any accident claims in the past 5 years?
- 是 / Yes
- 否 / No
描述*
Description
过往5年内是否有过犯罪记录或者驾照被吊销？*
Has there been any criminal convictions and/or licence suspensions in the past 5 years?
- 是 / Yes
- 否 / No
- 添加驾驶者 Add another driver
驾驶者2*
Driver 2
姓 Last Name 名 First Name
性别*
Gender
驾照签发年份*
Year Licensed
出生日期*
DOB
DD slash MM slash YYYY
过往5年内是否有事故索赔记录 ?*
Are there any accident claims in the past 5 years?
- 是 / Yes
- 否 / No
描述*
Description
过往5年内是否有过犯罪记录或者驾照被吊销？*
Has there been any criminal convictions and/or licence suspensions in the past 5 years?
- 是 / Yes
- 否 / No
- 添加驾驶者 Add another driver
驾驶者3*
Driver 3
姓 Last Name 名 First Name
性别*
Gender
驾照签发年份*
Year Licensed
出生日期*
DOB
DD slash MM slash YYYY
过往5年内是否有事故索赔记录 ?*
Are there any accident claims in the past 5 years?
- 是 / Yes
- 否 / No
描述*
Description
过往5年内是否有过犯罪记录或者驾照被吊销？*
Has there been any criminal convictions and/or licence suspensions in the past 5 years?
- 是 / Yes
- 否 / No
- 添加驾驶者 Add another driver
驾驶者4*
Driver 4
姓 Last Name 名 First Name
性别*
Gender
驾照签发年份*
Year Licensed
出生日期*
DOB
DD slash MM slash YYYY
过往5年内是否有事故索赔记录 ?*
Are there any accident claims in the past 5 years?
- 是 / Yes
- 否 / No
描述*
Description
过往5年内是否有过犯罪记录或者驾照被吊销？*
Has there been any criminal convictions and/or licence suspensions in the past 5 years?
- 是 / Yes
- 否 / No

保存表格，稍后继续 / Save and Continue Later

提交申请
被保险人是否曾被保险公司取消合同或拒绝续保？*
Had insurance cancelled or declined by an Insurer ?
- 是 / Yes
- 否 / No
被保险人曾宣布破产？*
Ever been declared bankrupt or gone into liquidation?
- 是 / Yes
- 否 / No
被保险人是否曾因犯罪行为被控告或定罪？*
Ever been charged or convicted of a criminal offence ?
- 是 / Yes
- 否 / No
申请人*
Applicant
电话*
Contact Number
邮箱*
Email
备注信息
Notes
声明 Declaration*
By submitting this Declaration, I acknowledged that I am authorised by all the Applicants to make this Declaration and the contents of this form are true and complete. Applicants are under a continuing obligation to immediately inform the insurer of any change in the particulars or statements contained in this form up until the contract is entered into. I have read, understood and accept the Terms and Conditions & Privacy Collection Notice.
- 我承认保险合同所有申请人均授权本人作为代表签署本声明并且此表格的内容真实完整。
- 我已认真阅读并同意相关服务条款和隐私政策。
签署日期*
Date of Application
DD slash MM slash YYYY

保存表格，稍后继续 / Save and Continue Later

Financial Service Guide | Privacy | Complaint | Code of Practice

Aushine Insurance Pty Ltd ABN 83 632 949 172 is an Authorised Representative 001275756 of Insurance House Pty Ltd ABN 33 006 500 072 AFSL 240954

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