Proposed period of insurance

4.00pm local standard time.(Insured period cannot exceed 12 months)

Proposer

Include all proposer´s names, trading names & subsidiaries

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  Yes No


Vehicles to be insured

(If insufficient room, please supply separate list as per details below) NB. Sums Insured to include cost of all fixed accessories, including tarps, gates, load binders etc., plus any non standard equipment such as refrigerators, TVs etc which are to be listed separately and less the GST amount if you are registered for GST.

  Yes No
  Yes No
  Yes No
  Yes No
  Yes No
  Yes No
  Yes No
  Yes No
  Yes No

Operations Details

  Yes No
  Yes No
  Yes No

Please provide details of types of loads and percentage of total work

Hazardous Goods

(Please note cover is restricted to the standard policy limits unless agreed in writing by ATL)
If you carry Hazardous Goods, please provide details below:

  Yes No
  Yes No
  Yes No

Proposer’s History(All proponents)

  Yes No
  Yes No

  Yes No
  Yes No
  Yes No
  Yes No

  Yes No

  Yes No
  Yes No
  Yes No

Acknowledgement of terms of business


Your Duty of Disclosure

In accordance with the provisions of the Insurance Contracts Act 1984 (Section 22), we are required to advise you of your responsibilities in relation to the disclosure of relevant information.

Before you enter into a Contract of General insurance with an Insurer, you have a duty under the Insurance Contracts Act 1984 to disclose to the Insurers every matter that you know, or could reasonably expect to know, is relevant to the Insurer’s decision whether to accept the risk of insurance and, if so, on what terms. You have the same duty to disclose those matters to the Insurer before you renew, extend, vary or reinstate a Contract of General Insurance. Your duty however does not require disclose of matters:
a) that diminishes the risk to be undertaken by the Insurer;
b) that is common knowledge;
c) that your Insurer knows or, in the ordinary course of business, ought to know;
d) as to which the compliance with our duty is waived by the Insurer.

Non-Disclosure

If you fail to comply with your Duty of Disclosure, the Insurer may be entitled to reduce the liability under the Contract in respect of a claim or may cancel the Contract.

If your non-disclosure is fraudulent, the Insurer may also have the option of avoiding the Contract from its beginning.

Declaration

I declare that the contents of this form are true and that I have not omitted any material information. If this information differs before the contract of insurance is concluded, I will tell the Insurers.

  I have read and agree to the Duty of Disclosure.

 

Head Office

10/39 Eucumbene Drive Ravenhall VIC 3023

 

Contact Us

Phone: 03 8358 5977

 

Email

[email protected]