Commercial Rental Fleet Insurance Application Form

Your Details

Name*

First Last

Address*

Street Address Suburb State Postal Code

Contact Number*

Email*

Full Insured Name (i.e. Legal Entity)*

Business Trading Name

ABN

Business Address*

Street Address Suburb State Postal Code

Do you have any other business locations?*

Address for other locations

Street Address

Suburb

State

Postal Code

Do you use Smash repairers to rent your vehicles?*

Are all vehicles owned and registered in the above business name?*

Are any of the vehicles under finance/or have financiers noted ?*

Lender Details

How long has the business been in operation (years) ?*

Fleet Manager Details*

Full Legal Name

Age

Number of years experience in the hire industry

Number of Staff*

About your Vehicles

Please provide a description of the fleet, specifying the number of units in each category.

Sedan, hatch, wagon up to $30K

Sedans, hatch, wagon $30K - $60K

Sedans, hatch, wagon $60K - $150K

2WD utes & 2WD SUVs

4WD utes & 4WD SUVs

Campervans, camper trailers & caravan

Trailers & scooters

Vans >21 seats

Vans <21 seats

Trucks <5t (and registered plant & equipment)

Trucks >5t

Unregistered plant & equipment

What was your fleet number for the last year (i.e how many vehicles were in your fleet)?*

What was your fleet number 2 years ago?*

Do you have GPS trackers or other telematics in/on any of your vehicles ?*

Are any of the vehicles fitted with any non standard accessories or modifications?*

Important Documents

Please provide a copy of your vehicle schedule, preferably in table format providing year, vehicle make, model, and registration

Max. file size: 1 GB.

Do you currently have a rental agreement?

Please provide a copy of the rental agreement document including all terms and conditions

Max. file size: 1 GB.

Claims History

Have you had any claims?*

In the last 3 years, have you or any staff drivers had any licence cancellation, disqualifications or suspensions?*

In the last 5 year's, have any of the staff drivers of the vehicles had any criminal, drink or drug driving convictions or know of any such charges pending?*

Current Business Practices

Do you store any non utilised vehicles on your business premises overnight?*

Number of vehicles kept overnight

How are they stored?

Are any vehicle’s keys ever stored in a lock-box or drop-box that is not secured within a locked building?*

Please provide details

Where are the keys to the vehicle/s stored during office hours?*

Where are the keys to the vehicle/s stored after office hours?*

What radius do you allow vehicles to travel from base?*

Do you have a weekly kilometre usage allowance ?*

What age groups do you rent to?*

Under 21

Under 23

Under 25

Over 75

All age groups

What is the daily charge for your collision damage waiver?*

What amount do you sell your collision damage waiver from?*

What amount do you lower your collision damage waiver amount?*

Please provide additional information on your hire conditions*

Customer Declaration & Duty of Disclosure

Has any insurer declined insurance to you, any partner, director or principal?*

Has any insurer cancelled or refused to renew your policy?*

Has any insurer required an increase in premium or imposed special conditions?*