For acceptance,
every question must be fully answered.
|
| Insured Name in Full |
|
| Contact Person |
|
| Address Line 1 |
|
| Address Line 2 |
|
| Post Code and State |
|
| Business Phone |
|
| Mobile Phone |
|
| Home Phone |
|
| Email Address |
|
| Date of Birth |
|
| Occupation |
|
Date coverage needs to be effective
|
|
| Note: Cover can only commence
from payment of premium, usually faxed or phoned authorised
credit card. Upon receipt of premium payment, completed proposal
and photo within 30 days of binding, the file will be complete.
If file is not complete within 30 days, we will process cancellation.
Please nominate which of the sanctioning bodies you race
under and the sub-class.
Note: You must specify racing classification in order to
obtain quote.
|
| Sanctioning Body |
Sub-Class |
|
NASCAR / AUSCAR |
|
|
ANDRA |
|
|
CAMS |
|
|
NASR |
|
|
Other
|
|
| |
|
| Principal location of racecar. |
|
|
| Will vehicle ever be loaned or rented to others? |
Yes |
No |
| Will vehicle be garaged at above location? |
Yes |
No |
| Will the garage be locked? |
Yes |
No |
| Will more than one vehicle be stored in this
garage? |
Yes |
No |
| If yes, please explain. |
|
| What is the construction of storage building/area? |
Wood |
Brick |
| Are doors locked at all times? |
Yes |
No |
| If no, please explain. |
|
| Number of windows? |
|
| Are they locked? |
Yes |
No |
| Are they barred? |
Yes |
No |
| Number of fire extinguishers in garage? |
|
| Is there an alarm system installed and in working
condition? |
Yes |
No |
| If car is stored in trailer, state precautions
taken to avoid theft. |
|
What other precautions have ben taken to reduce
loss?
|
|
|
| What is the longest distance (kilometres) to
be travelled from principal location of race vehicle? |
|
| How many kilometres do you travel annually? |
|
| Which states do you travel to (including principal
location)? |
QLD |
NSW |
|
VIC |
WA |
|
ACT |
SA |
|
TAS |
NT |
|
Inventory List
Include race vehicles, trailers, spare parts, engines, tools
etc |
| Vehicle Type |
Engine Make & Capacity |
Sum Insured |
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|
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| |
|
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| Accessories, Parts, Equipment, Tools |
Sum Insured |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| Trailer Size and Description |
Sum Insured |
|
|
|
|
|
|
|
|
|
| |
|
|
| Total Sum Insured |
|
|
Your Duty of
Disclosure
Before you enter into a contract of general insurance with
an insurer, you have a duty, under the Insurance Contracts
Act 1984, to disclose to the insurer every matter that you
know, or could reasonably be expected to know, is relevant
to the insurer's decision whether to accept the risk of insurance,
and if so on what terms.
You have the same duty to disclose those matters to the insurer
before you renew, extend, vary or reinstate a contract of
general insurance.
Your duty however does not require disclosure of matter
- that diminishes the risk to be undertaken by the insurer
- that your insurer knows or in the ordinary course of his
business, ought to know
- as to which compliance with your duty is waived by the insurer.
Non-Disclosure
If you fail to comply with your duty of disclosure, the
insurer may be entitled to reduce his liability under the
contract in respect of a claim or may cancel the contract.
If your non-disclosure is fraudulent, the insurer may also
have the option of avoiding the contract from it's beginning. |
