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About
Services
Policy Information
Policy Wordings
Recycling
Quotes
Claims
Common Area Liability
Contact us
Caravan/Motor Home Quote Request
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Insured Details
Name
*
First
Last
Postal Address
Address Line 1
City
State / Province / Region
Postal Code
Phone
Email
*
Caravan Details
Year of Manufacture
Make
Model
Series
Length
Sum Insured Required for the Caravan/Motor home
Sum insured required for contents within the Caravan/Motor home
Does the Caravan/Motor Home have any accessories or modifications? If so, please provide details of each item and their indivdual value:
Does the Caravan/Motor home have any existing damage?
Yes
No
Is the Caravan/Motor home registered/roadworthy and safe to drive?
Yes
No
Has the Caravan/Motor home been converted or modified?
Yes
No
Is the Caravan/Motor home undergoing any repairs or alterations?
Yes
No
Registration Number
V.I.N Number
Chassis Number
Is the Caravan used privately or for a business?
If the caravan is used for business, please provide details of the business
What is the address for where the caravan/motor home is kept?
Address Line 1
City
State / Province / Region
Postal Code
How is the caravan stored?
Garage
Carpet
On the property
Other
If "Other", please advise
Is your caravan/motor home under finance?
Yes
No
If under finance, please advise the name of the Financier
Annex Details
Year of Manufacture
Construction Type/Material Used
Current Estimated Value
Driver Details
Please provide details of any person that will drive the motor home or tow the caravan.
Name
D.O.B
Number of years licensed
Name
D.O.B
Number of years licensed
Name
D.O.B
Number of years licensed
Driving History
Has any Insurer in respect of any Insurance Policy:
Had a claim whether at fault or not
Has a loss of license or suspension
Had any traffic infringements excluding parking fines
None of the above
If you answer yes to any of the above, please provide details including a brief description, date and cost
Disclosure Questions
Has any Insurer in respect of any insurance policy:
Refused to renew/cancel or terminate a policy
Refused a claim or required an increased premium under a policy
Imposed special conditions under a policy
None of the Above
If you answer yes to any of the above, please provide details below:
Have you been:
Convicted of any criminal offence
Been Declared Bankrupt
None of the Above
If you answer yes to any of the above, please provide details below:
Current Insurer Details
Who is the current Insurer of the caravan/motor home?
What is the current renewal premium
What is the current policy excess
What date is cover required to start
Submit
Secure online payment
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Common area liability
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Freight Insurance Services
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Recyle
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