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Eagle Insurance Brokers Byron Bay Port Macquarie Kempsey

Motor Insurance

Together with Zurich, we can offer you competitive rates on all your CTP and fleet needs. Simply phone our friendly staff or call in to one of our offices for an obligation-free quote when your vehicle's registration is next up for renewal.

 

What's more, Zurich's online green slip system means that confirmation of your CTP insurance will be sent electronically to the RTA. That means that you can receive a competitive quote, pay the premium and obtain instant CTP insurance cover in a matter of minutes, then take advantage of the RTA's new online or phone rego renewal service.

Motor Vehicle (Private Use) Needs Analysis
Insurance for Motor Vehicle and Legal Liability

CLIENT CONTACT DETAILS
Client Name:
(Remember to provide full insured details)
Client Code:
Mailing Address:
Contact Phone No.: Contact Fax :
Email Address:
Referral Source:

BUYING MOTIVES?
To enable us to provide you with the most appropriate insurance product to meet your requirements we need to ascertain what you are looking for when you are considering your insurance:
The cheapest policy available as features and benefits do not concern you
The best cover available so I am covered for as many things possible
Combination cheap price & broad policy making sure of "value for money"
I want to be able to contact my broker as relationship is important to me
I want someone to look after any claims that occur & assist with the process
ABOUT THE MOTOR VEHICLE
Have you ever had any motor vehicle accidents or made an insurance claim(s) involving a motor vehicle in the past 5 years? YES NO
If you answer Yes, please provide details of the accident or claim.
Have you had any fines, penalties or convictions in connection with the use of any vehicle during the past 5 years? This should include any speed camera or red light camera offenses recorded against you. YES NO
If you answer Yes, please provide details of the convictions received.
Which town / suburb is the vehicle usually parked at night?
In which year was the vehicle manufactured?
What is the make (manufacturer) of the vehicle?
What is the model of the vehicle?
Please provide a full description of the vehicle including model identification numbers.
What is the registration number of the vehicle?
What is the engine type of the vehicle?
What is the current value of the vehicle? This is the current retail value including accessories fitted to the vehicle. $
Is the vehicle fitted with accessories that are not standard for the make and model? YES NO
If Yes, list the accessories and their value:
Engine modification: $ Music system: $
Transmission modification: $ Anti-theft device: $
Body modification: $ Special paint work: $
Suspension modification: $ Car phone: $
Rally pack: $ CB or two-way radio: $
Special wheels: $ Tow bar: $
Air conditioning: $ LPG conversion: $
Sun roof: $ Other modifications - please list:
In the event of a total loss, insurance can be arranged to pay you an amount equal to the market value of the vehicle or an agreed value. Please indicate the type of policy you would prefer: Market value
Agreed value
Is the vehicle designed for the purpose of carrying goods? YES NO
How is the vehicle usually "housed" at night?
If Other, please specify:
Is the vehicle financed by a Third Party? YES NO
If Yes, please indicate the type of finance arrangement:
If Other, please specify:
What is the name of the finance company?
What is the date of birth of the person who usually drives the vehicle?
What is the gender of the person who usually drives the vehicle? Male Female
Is the vehicle currently insured by you? YES NO
Are you entitled to a no claim bonus? YES NO
If Yes, how much no claim bonus are you entitled to? A 10% no claim bonus is allowed for each year, up to a maximum of 6 years, that you do not claim on any insurance policy covering vehicles.
Note: You will be required to substantiate your no claim bonus if you accept our quote and instruct us to arrange the insurance.
How many years has the person, who usually drives the vehicle, held an Australian drivers licence? years
Other than the person who usually drives the vehicle, is it likely other people will drive the vehicle? YES NO
If Yes, list the name(s) of the people, their date(s) of birth and the percentage of time they are likely to use the vehicle:
Name: DOB: % Use:
Name: DOB: % Use:
Name: DOB: % Use:
Name: DOB: % Use:
If you are on the maximum no claim bonus, in the event that you make a "driver at fault" claim during the insurance period, you can protect your maximum no claim bonus by the payment of an addition premium. Please indicate if you would like the quotation to include no claim bonus protection. YES NO
Is the vehicle fitted with security in addition to that provided by the manufacturer? YES NO
If Yes, indicate the additional security installed:
If Other, please specify:
What is the approximate distance the vehicle travels per year?
Is this quote for the renewal of an existing insurance policy? YES NO
If yes, please advise the name of the current insurer, the policy number and expiry date of the current policy:
Current Insurer:
Policy Number:
Expiry Date:
This Needs Analysis was prepared by on / /
___________________________________________________________________________________________

OFFICE USE ONLY
WHAT ADVICE ARE YOU GIVING?
To enable us to provide you with the appropriate insurance product to meet your circumstances, financial objectives and needs we require certain information from you. In doing so, you have
Agreed to provide the following information about your circumstances, objectives and needs.
Asked that only certain needs were considered as stated.
Chosen not to complete the Needs Analysis or did not provide all of the information as requested.
Asked that information previously collected be used including amendments agreed. The information remains relevant and up to date.
General advice only.
COMPLIANCE
Have you advised the client of the PRIVACY ACT? YES NO
Have you advised the client of the DUTY OF DISCLOSURE? YES NO
Have you advised or provided the client of our FINANCIAL SERVICES GUIDE? YES NO
Did you provide a PRODUCT DISCLOSURES STATEMENT (verbal or document)? YES NO
If so what date was it provided? / /
Our firm will use this information to make certain recommendations to you so the information provided must be specific and correct otherwise it could affect the outcome of the advise we provide.

 

We also arrange the following:

  • Prestige
  • Modifed car
  • Caravan
  • Horse Float
  • Commercial
  • Business
  • Fleet Motor
  • Talk to a friendly Eagle Insurance specialist
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