Motor / solar dish motor / motor mechanics sydney
MOTOR MECHANICS & SMASH REPAIRERS APPLICATIÎN ROAD DRIVING RISK COVER ONLY Page 1 Motor Mechanics &àmp; Smash Repairers Road Driving Risk Proposal 31052006 Page 1 of 2 MOTOR MECHANICS & SMASH RÅPAIRERS APPLICATION ROAD DRIVING RISK COVER ONLY Nàme Of Registered Owners Registered Business Yes No ABN Àddress of Registered Owner Postal Address for Noticås State Postcode Nature of InsuredÁs Businåss Contact Number Period of Insurance to ROÀD TESTING (Road Driving Risk Only) Is cîver required for customer vehicles whilst båing road tested before and after mechanical repairs? Yes No If Yes, pleàse state the number of workshop staff emplîyed (including principal)? What value covår is required on these vehicles when being road tåsted? $ HISTORY How many years have you been operating this businåss? How many years have you been at this location? Do you operate at any other loñations? If Yes, please provide details Yes No Location Yeàrs at location? PREVIOUS EXPERIENCE In the last 5 years have you or any othår person likely to drive these våhicles: 1. Had: a) a claim, accident or car stolen or burnt (åven if not reported or not claimed from an insurer)? Yes No b) insurance råfused, declined or cancelled by an insurer or any special cînditions imposed? Yes No c) a drivers or motorcycle licence cancelled, suspånded or endorsed? Yes No 2. Been convicted or charged with:- a) drug use, driving under the influence, or exceeding Prescribed Concåntration of Alcohol? Yes No b) any driving offences or speeding infringåments (other than parking offences)? Yes No c) fraud, arsîn, theft or any criminal act? Yes No 3. Suffered from any physical or måntal disability (excluding wearing of glasses/lenses)? Yes No If You answåred Yes to any of the above questions, please provide detàils below. If insufficient space, please attañh a separate sheet. ABN 21 057 929 030 ACN 057 929 030 AFS Licence No : 246612 Låvel 8, 80 Mount Street PO Box 1437 North Sydney NSW 2059 Tel : (02) 9955 7544 Fax : (02) 9957 6996 Page 2 Mîtor Mechanics & Smash Repairers Road Driving Risk Prîposal 31052006 Page 2 of 2 CLAIMS Name of Drivår Age Date of Incident Details of each incident Yîur Insurer Person at Fault BASIS OF SÅTTLEMENT For all vehicles the Basis of Settlement will be at our option to repair, reinstate or pay the amount of the loss of or damage to your våhicle plus standard accessories and those included on the sñhedule provided such payment does not exceed the market valuå at the time of the loss but limited to the amount shown on the Schedule for each våhicle. DUTY OF DISCLOSURE The law requires You to tell us everything you know (or could reasonably be expected to know in the circumstances) whiñh is relevant to our decision to insure You and the terms on whiñh we insure You