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Renewal Declaration Form
Have you changed your address?
Do you use any Subcontractors ?
How many staff do you have (including yourself)
Item Carrier (I.E.Machinery, General Freight, Livestock)


Do you wish to change your sum insured?
Would you like a quote to include vehicle downtime cover?
The following questions relate to any director, partner, manager and drivers of insured vehicles.
Have any driver under 25 years of age?
Held an Australian licence for less than 2 years for the applicable vehicle class driven?
Had a traffic infringement in the last 2 years?
Had a loss of licence, DUI or Drug offense in the last 5 years?
Been declared bankrupt or put into receivership or liquidation?
Been charged with or convicted of a criminal offence?
You are the listed insured, or authorised by the listed insured to organise insurance on their behalf.
If there is more than one insured, you are authorised to organise insurance on their behalf, and that if you disclosed personal information about any insured person or any other person, you have made them or will make them aware that you have provided their personal information to us and the types of third parties we may provide it to, the relevant purposes we and third parties will use it for, and how the insured person or other person can access it:
The disclosed information is true and correct:
You have not withheld or supressed any information concerning the details of this application:
You have read the above duty of disclosure and are aware that should you not fully and truthfully disclose all relevant information, an insurer may decline a claim or void a policy
You consent that any personal information you provide to Insurance HQ will be collected, stored, used and disclosed in accordance with our Privacy Policy/Financial Services Guide. We may provide your information to insurance companies and other intermediaries in order to provide insurance quotes and offer insurance terms to you or the companies that deal with your insurance claim (such as loss assessors and claims staff).