Commercial Motor NON QLD Client Code*Name of person completing questionnaire*Insured Name*Commercial Motor Vehicle Insurance1. If you Hire-In Plant or Vehicles (Including Trailers), please advise the estimated maximum duration of each hire and also the highest valued item.*2. If not already provided in your Policy are you interested in excess free windscreen cover for an additional premium?* Yes No 3. If available, are you interested in covering the hire costs for a similar vehicle following an accident?* Yes No 4. Are there any changes in your business activities/operations?* Yes No If YES, please advise full detailsDriver Disclosures:5. Please provide details of any person under 25years of age or with less than two (2) years driving experience, that may drive or operate any of the insured units:*6. Details of any Motor Insurance and/or claims refused and/or cancelled and/or imposed special terms in the last five (5) years:*7. To the best of your knowledge, details of any convictions for driving under the influence of alcohol or drugs (DUI) and/or exceeding the prescribed content of alcohol (PCA) in the last three (3) years:*8. To the best of your knowledge, have any employed drivers had a licence suspended or cancelled in the last five (5) years?*If YES, please advise full details9. To the best of your knowledge, have any employed drivers been convicted of a total of more than two (2) traffic offences (excluding parking) in the last three (3) years?*If YES, please advise full detailsClaims10. Details of any claims that have occurred, but have not yet been reported*11. After specific inquiry, details of any facts, circumstances or incidents (other than those already disclosed, notified to your insurer) which could give rise to claims in the future.* All changes or inclusions of any sort or type, including limits or sums insured shown, will take effect from the policy's expiry date unless you request otherwise.Office Message RecipientSelect the office you want to which you wish to send your message* Maroochydore Townsville Proserpine Mackay Ingham Information we have provided is to the best of our knowledge correct.NameThis field is for validation purposes and should be left unchanged.Δ