Car Insurance - Insurancesave

INSURANCESAVE.CO.NZ

BEST RATES BEST COVER

GET A QUOTE NOW

AND SAVE ONLINE WITH

INSURANCESAVE.CO.NZ




Become an agent

HAVE YOU OR ANY PROPOSED DRIVER OF THE VEHICLE

Been convicted for driving under the influence of drugs or alcohol?

Been convicted for negligent, dangerous or reckless driving?

Had their drivers licence suspended or cancelled for any other reason than above?

Had insurance declined or cancelled or had a claim refused for fraud?

Had any non-traffic criminal convictions?

The answer to all of the above questions is “Never, or over 5 years ago”

The answer to at least one of the questions is “Yes”

PERSONAL DETAILS

Title*

First Name*

Last Name*

Date of Birth*

Gender*

Male

Female

CONTACT DETAILS

Street*

Suburb*

Postcode

Town/City*

Mobile Phone Contact*

Land Line Phone Contact*

Contact Email*

VEHICLE DETAILS

Make*

Model*

Sub Model*

Year*

Registration*

Purchase Price*

Confirm the total value of non-standard accessories (i.e. mags, stereo, GPS)*

Sum Insured Value*

Area of Garaging*

Overnight Parking*

Vehicle Use*

Private

Business

Annual Distance Driven*

Does any party have a financial interest in this vehicle?*

Yes

If so whom? (List person or finance company here)*

Would you like under 25 drivers to be covered?*

Yes

(selecting no will reduce your premium)

% Driver Uses Vehicle*

% (i.e. 95%)

SECONDARY DRIVER
("Named Drivers over 25 will reduce the Insurance Premium" )

Title

First Name

Last Name

Date of Birth

Gender

Male

Female

License Class

Country License Issued In

% Driver Uses Vehicle

% (i.e. 5%)

The number of motor vehicle accidents the driver has had in the last 5 years

The number of at-fault motor vehicle accidents the driver has had in the last 5 years

Terms & Conditions