Vehicle Details
Does the vehicle have any modifications or accessories installed which were not supplied or fitted by the manufacturer as standard equipment for your make and model, such as audio equipment, lowering, engine modifications?
Is the vehicle: V8/V10/V12, Turbo, Supercharged, Rotary, Electric?
Does the vehicle have an alarm, immobiliser, GPS tracker, or any other security device installed?
Does the vehicle have any un-repaired or pre-existing damage – including mechanical?
Is the vehicle parked at this address?
What is the parking situation? E.g. Garage, driveway, street etc.
What options would you like to include with your quote?
Vehicle Owner's Details
Do you have or have you had car insurance in the last 2 years?
Does this driver hold a Passenger Endorsement on their license?
Club Auto policies only cover those people who have been named as drivers.
Disclosure
In the last five years, have you or any of the other drivers had any accidents, damage, or theft, whether a claim was made or not, regardless of fault?
In the last five years, have you or any of the other drivers had a driver licence endorsed, suspended, cancelled, or disqualified?
In the last five years, have you or any of the other drivers been charged with, convicted of, or committed any driving or vehicle-related offences (excluding parking offences)?
Have you or any of the other drivers had insurance declined, cancelled, refused renewal, or had special terms imposed?
Have you or any of the other drivers ever had an insurance claim declined?
In the last ten years, have you or any of the other drivers been charged with, convicted of, or committed any criminal offence, or been declared bankrupt?
Is there any other information that may be relevant to our assessment of your insurance quote request?
Privacy Information
Information that you supply to us (including personal information) may be held and used by Club Auto Insurance (NZ) Limited and our nominated Binding Insurer, TOWER Insurance for the purpose of providing you with insurance quotes. Any personal information that you provide Club Auto will be collected and held by Club Auto and our nominated Binding Insurer. The Privacy Act entitles you to have access to, and request correction of, this information which you may do by contacting us on 0800 506 506 or emailing sales@clubauto.co.nz. Failure by you to provide accurate and complete information may result in your application for insurance being declined, your claim being reduced or declined, or we may void your policy from the outset. If anything changes, you must tell us. Where you provide us with personal information about any other person to enable us to underwrite your insurance, you confirm that you have the authority from those people to disclose such information. Any quote you receive from Club Auto Insurance has been based on information that you have supplied, this is given as INFORMATION ONLY. You should always seek your own financial advice prior to accepting any insurance policy. You may view Club Auto's policy wordings on our website at any time prior to making YOUR decision.
