Motorcycle Insurance

Duty of Disclosure

What you must tell us
When answering our questions, you must be honest and you have a duty under the law to tell us anything known to you, and which a reasonable person in the circumstances, would include in answer to the questions. We will use the answers in deciding whether to insure you and anyone else to be insured under this insurance and on what terms.

Who needs to tell us
It is important that you understand you are answering our questions in this way for yourself and anyone else who is an insured under this insurance.

If you do not tell us
If you do not answer our questions in this way, we may reduce or refuse to pay a claim, or cancel your insurance. If you answer our questions fraudulently, we may refuse to pay a claim and treat the insurance as never having worked.

Do you understand and accept your duty of disclosure?

Yes No

About the Proposer

Title:

Mr Mrs Miss Ms

First name:

Surname:

Email address:

Garaged address:

Postal address:
if different from garaged address

State:

Post code:

Contact number B/H (daytime):

Contact number A/H:

What type of cover are you interested in?

On what basis do you want your motorcycle to be insured?

If Agreed Value, what value do you wish to ensure your motorcycle for?
Enter whole dollars only.

Are you licensed to ride the motorcycle to be insured?

Yes No

Type of motorcycle licence?

Year of manufacture

Make

Model

Cubic capacity

Does your motorcycle have any non standard accessories or modifications?

Yes No

If yes, please provide the total value of these non standard accessories and modifications.
Enter whole dollars only.

Has the motorcycle been purchased yet?

Yes No

If yes, what is/was the purchase price (including on road costs)?
Enter whole dollars only.

Purchase date
Please enter dd/mm/yyyy.
If you can't recall the exact date please record an estimate.

Is the motorcycle under finance?

Yes No

Birth date of proposer:

Birthdate of youngest rider:

Where is your motorcycle normally parked at night?

What type of residence do you live in?

How many kms do you ride each year?

For what purpose do you use your motorcycle?

If Business or Commercial, what type of business?

If Business or Commercial, do you spend most of your time on your motorcycle or at your work place?

Do you currently have a No Claim Bonus or rating on a car or motorcycle?

Yes No

If yes, what is the no-claim bonus or discount rating?

Have any of the riders in the last five years been charged or summonsed for: a) riding or driving while unlicenced, suspended, disqualified, or cancelled? b) dangerous, reckless or careless riding or driving?

Yes No

If yes, please provide details of the charges including dates:

Have any of the riders in the last five years: a) had their licence (motorcycle or motor vehicle) suspended, disqualified or cancelled? b) had an alcohol or drug related riding or driving conviction, infringement or offence? c) refused to take a breath test or breath analysis? d) had any other traffic, riding or driving conviction, infringement or offence (including on the spot fines)?

Yes No

If yes, please provide details of the offence/s including dates:

Have any of the riders in the last five years had a motorcycle or motor vehicle: a) accident at fault or not? b) stolen or burnt? c) claim against an insurance company? d) accident causing death?

Yes No

If yes, please provide details of the accidents/s including dates:

Have any of the riders in the last ten years been convicted or charged for: a) theft of a motorcycle or motor vehicle? b) arson? c) burglary? d) fraud e) a criminal offence of any kind?

Yes No

If yes, please provide details of the conviction/s including dates:

Have any of the riders had any insurance policy cancelled, renewal refused, cover declined or special terms imposed?

Yes No

If yes, please provide details:

Have any of the riders been declared bankrupt?

Yes No

If yes, please provide details:

Is the main rider a member of a motorcycle club?

Yes No

If yes, which club/s?

Click the button below to transmit your information to QBE motorcycle insurance. Your response will be emailed to you promptly.

Please note that this is an indicative quote and acceptance is based on our standard underwriting guidelines.

Please note, QBE will not sell or pass on your details, however some parties may be able to read your transmission.

Please click here to view QBE's Privacy Promise.

Please click here to view QBE's PDS and Policy Wording.

Please click here to view the Financial Services Guide (FSG)