Renewal Declaration –Truck - Truck Insurance HQ
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    Client Detail




    Marine Cargo Declaration


    Item Carried (I.E. Machinery, General Freight, Livestock)


    Do you wish to change your sum insured?
    YesNo
    Would you like a quote to include vehicle downtime cover?
    YesNo
    The following questions relate to any director, partner, manager and drivers of insured vehicles.
    Have any driver under 25 years of age?

    YesNo

    Held an Australian licence for less than 2 years for the applicable vehicle class driven?

    YesNo

    Had a traffic infringement in the last 2 years?

    YesNo

    Had a loss of licence, DUI or Drug offense in the last 5 years?

    YesNo

    Been declared bankrupt or put into receivership or liquidation?

    YesNo

    Been charged with or convicted of a criminal offence?

    YesNo

    Duty of Disclosure
    You are the listed insured, or authorised by the listed insured to organise insurance on their behalf.

    YesNo

    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:

    YesNo

    The disclosed information is true and correct:

    YesNo

    You have not withheld or supressed any information concerning the details of this application:

    YesNo

    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

    YesNo

    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). We also may utilise the services Ins HQ (Asia) LLC Company Limited in processing and supporting our Australian staff:

    YesNo

    Would you like to speak to our staff in regards to any specific concerns:

    YesNo

    Would you like to speak to a specialist who can help with your life, trauma, total & permanent disablement, income protection and superannuation needs:

    YesNo

    Contact Us

    1300 815 344



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