Cover Type Motorcycle
Policy Cover type
Third Party Property Damage
Claim in the last 5 years
Motorcycle for private use only?
Year of Manufacturer
Is the motorcycle in Roadworthy Condition?
Is the motorcycle new or used?
Date of Birth of Oldest Insured
Year licence obtained
Underwriting Acceptance Criteria
Have you been declined insurance in the past 12 months
Number of criminal convictions in the past 3 years
Do you wish to Add Additional Driver to avoid additional excesses
Underwriters consideration & Comments (please provide details)
Additional Drivers First Name Surname Date of Birth Gender Year licence obtained Number of criminal convictions in the past 3 years Has there been any claims and/or licence suspensions in the past 3 years?
Vehicle sum insured (excluding non-standard accessories and modifications)
Sum Insured Option
Agreed Value Cover Required
MotorCycle Insurance Excess Option
Does the vehicle have any non-standard accessories that will be included within the cover?
Non Standard Accessories
Please supply a description of Non Standard Accessories to be Insured and the Sum Insured
Overnight parking address
Declaration: I/WE HEREBY DECLARE AND WARRANT that the answers given above are in every respect true and correct, and that I/We have not withheld any information within My/Our knowledge likely to affect the decision of the Company as to My/Our eligibility for insurance. This request and declaration shall be the basis of the quote request.
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Ausure Pty Ltd ABN 94 096 971 854 AFSL 238433