Truck Transport Insurance 1 Insured Details 2 Business Details 3 Insurance Cover 4 Motor Vehicle 5 Property Cover 6 Business, Cargo and Cyber 7 Declaration & Submit Introduction Please answer all questions in this proposal form. Blanks and/or dashes, or answers "known to underwriters or brokers" or "N/A" are not acceptable and will delay processing of this application. If there is insufficient room to complete a question, please attach a signed & dated addendum. Any documents attached to this document form part of this application. Where appropriate, please tick the yes or no box which best indicates your reply. If you have any questions whilst completing this insurance proposal form, please let us know. Thank you. Primary Contact First Name Last Name Job Title / Position Email Phone Mobile Primary Insured Insured Name If you are a sole trader, your name can be added here. Partnerships should list all partners’ full legal names. If you are a company, you should list the Pty Ltd entity name here. If you operate from a trust, you should list both the trust and the trustee here. If you need help you should call our office. Trading Name(s) ABN Year Business Established Exempt from Stamp Duty? NoYes Your business or depot address Please tell us where your primary location is or where you park your vehicles. Address 2 City State NSWVICQLDSAWATASACTNT Postcode What type of premise do you operate from? Additional Insureds Are there any other entities or individuals to be insured under this policy? NoYes Additional Insured 1 Insured Name Trading Name(s) ABN Year Business Established Registered for GST? NoYes Input Tax Credit (ITC) % Additional Insured 2 Insured Name Trading Name(s) ABN Year Business Established Registered for GST? NoYes Input Tax Credit (ITC) % Interested Parties Please list any Interested Parties required to be noted on the policy E.g., Tier 1 builders, your bank, or your landlord. Please list full legal names. Current Cover Do you currently have Truck Insurance or a Transport Insurance Package cover in place? NoYes Please provide the following details of your current policy: Name of Insurer Policy Limits Excesses Expiry Date of the current policy Required Period of Cover Start Date End Date Previous Next About your Business Next, tell us more about your business and what you do Please tell us what type of goods you carry Livestock / PoultryHorse / Bloodstock TransportTractor / Heavy Plant TransportBulk Grains / Harvested CropsFertiliserAlcohol / BeerSoft DrinksGeneral Groceries (Dry)Refrigerated / Chilled Goods or GroceriesBulk Milk TransportHanging MeatsFast Food Deliveries including Uber EatsMedical CourierCourier / Parcel DeliveryForestry / LoggingHot Mix / Bitumen / TarBricks / TilesMinerals or OreBuilding or Construction MaterialsConcrete (Agitator / Pump)Building / Earthworks - Green Fill or WasteBulk Soil / Sand / GravelDemolition & Construction WasteAsbestos TransportBulk PetrolBulk OilsBulk Trade WasteBulk Powdered GoodsHome RemovalistBusiness or Commercial RemovalistOver-Sized or Over DimensionTow Truck OperatorCar or Vehicle TransportBoats or Speciality VehiclesCaravans TransportWholesale or Retail GoodsOther (please specify) Estimated Gross Freight Earnings (GFE) for the next 12 months This is the total value you expect to invoice to your customers in the next 12 months. Estimated wages for the next 12 months Number of full time employees Number of part time employees Do you use Sub-Contractors as drivers? YesNo What do you estimate that you will pay to Sub-Contractors as drivers in total for the next 12 months? Previous Next Insurance Cover Details Please tell us about what type of insurance you require for your business. If you select yes, we will ask you some more questions to help get you quotes. This will not automatically provide you with cover; you must first accept any quotes we provide to you. Heavy Vehicles NoYes Light Vehicles - Utes & Vans NoYes Carrier's Cargo Insurance NoYes This is cover for damage to goods belonging to others whilst in transit, whilst loading or unloading during delivery, or for theft, pilferage or alleged non-delivery. This is not suitable for businesses moving goods they own. Transit / Cargo Insurance NoYes Cover for your own goods whilst in transit. This is appropriate for a business that does not transport the goods of others, such as a retail chain transporting their own stock between stores or a landscaper moving their own stock from their depot to the site. Public Liability Insurance for your Business NoYes This is your general public liability for your business and when out of your truck — for example, loading and unloading your vehicle. Property Cover for your Business Office or Depot NoYes Business insurance for your office, depot or storage facility. If you operate from home, your home insurance may not provide any cover for business-owned equipment or stock. Management Liability Insurance NoYes This is cover for directors of the company for their conduct as business owners, particularly around Workplace Health & Safety and Employment Laws. Cyber Insurance NoYes This is cover for your business and employee data and your customer's data, protecting your business against hacking, ransomware, altering invoices, and cyber crime. Previous Next Heavy Motor Vehicle Insurance In this section, please list all your rigid vehicles and light commercials other than utes or vans which are listed separately. Heavy Vehicle List Year, Make and Model Variant GVM Tare Weight Rego Sum Insured (Value) Accessories List Vehicle Rego List all Accessories Total Value of all Accessories Did you include accessories in Sum Insured Above? NoYes NoYes NoYes NoYes NoYes Driver List Name of Driver Date of Birth Number of Years Licensed in Class Which Vehicle do they operate? (Rego) Operating Distance How far in km do your vehicles operate from their home base / depot? Not sure how far you drive? GT Insurance have this handy distance calculator – GT Distance Calculator Additional Cover – Heavy Vehicles Trailers belonging to others in your control? NoYes What is the maximum value any one trailer? What is the minimum value any one trailer? Goods of others whilst on Hook? NoYes This is for units with a crane or tow truck operators Breakdown (Roadside Assistance) NoYes This isn’t offered by all insurers or on all types of vehicles. Dangerous Goods Transport NoYes What limit do you require for Dangerous Goods? Interruption – Substitute Vehicle NoYes Cover for the cost to hire a similar vehicle following damage to your vehicle. Interruption – Weekly Benefits for Loss of Income NoYes Cover for the loss of income whilst you are unable to trade due to damage to your vehicle. Interruption – Finance Payments NoYes Cover for your loan payments to your financier whilst your vehicle is in for repairs. Risk Management — Heavy Vehicles Generally, a well managed risk will often receive more favourable pricing and terms compared to a business that does not manage the risk as well. Looking for a Driver Declaration form to send to your drivers? Heavy Vehicles – Drivers Declaration Form What risk management processes and tools do you have in place on your Heavy Motor Fleet? My Drivers complete a Driving Induction TrainingAll my drivers complete a drivers declaration at least once a yearI ask my drivers to provide me with a RMS (or relevant state authority) Drivers History PrintoutI use dash cameras on all my vehiclesI use facial recognition technology (FRT) cameras within the cab to monitor driver eyes and head position to manage fatigue Would you like to attach a Drivers Declaration form for each of your drivers? NoYes Would you like to attach a photo of each of your vehicle(s)? NoYes This helps the insurer see vehicle condition. Optional. Light Vehicles — Sedans, Utes, Vans, Wagons In this section, please list all other light vehicles. This includes all utes, vans, sedans, 4WDs, and wagons. Light Vehicle List Year, Make and Model Variant (Badge) Rego Sum Insured (Value) Your preferred cover type Accessories List Vehicle Rego List all Accessories Total Value of all Accessories Did you include accessories in Sum Insured Above? NoYes NoYes Additional Cover — Light Vehicles Excess free Windscreen Replacement NoYes Hire Car following an Accident NoYes Breakdown (Roadside Assistance) NoYes Risk Management — Light Vehicles Generally, a well managed risk will receive more favourable pricing and terms. Looking for a Driver Declaration form to send to your drivers? Sedan and Light Vehicle – Driver Declaration What risk management processes and tools do you have in place for your Light Vehicles? My drivers complete a Driving Induction TrainingAll my drivers complete a drivers declaration at least once a yearI ask my drivers to provide a Drivers History Printout (state authority)I use dash cameras on all my light vehiclesI use facial recognition technology (FRT) cameras to monitor driver eyes/head position for fatigue Would you like to attach a Drivers Declaration form for each of your drivers? NoYes Would you like to attach a photo of each of your light vehicle(s)? NoYes Optional, but helps insurers assess vehicle condition. Previous Next Property Cover for your office, warehouse or depot Location 1 Insured Location Address Insured Location Address 2 Insured Location City Insured Location State Insured Location Postcode Do you rent or own the Premises? RentOwn Do you have a Cold Goods Storage on site NoYes Other Year Built Wall Construction Material(s) Brick VeneerDouble Brick or Concrete BlocksStoneConcrete Tilt SlabConcrete (Rendered Finish)Hardie Plank (Cement Boards made to look like Timber)Fibro CementTimberWeathertexColourbond, Zincalume or SteelMudbrickAluminium Composite Panel (ACP)Other Sandwich Panel or Structural Insulated Panel (SIP) System Select all that apply Roof Construction Material(s) Concrete SlabColourbond / Zincalume / SteelMetal (I'm not sure what type of metal)AsbestosConcrete TilesTerracotta or Slate Tiles Select all that apply What type of Structural Flooring do you have? Concrete Ground LevelConcrete Upper Level(s)Timber Ground LevelTimber Upper Level(s)Metal Upper Level(s) Select all that apply. At this location, would you like to include cover for: Material Damage (Fire, Storm etc) to your business propertyBurglaryGlassYour Money / CashBreakdown of Machinery or Electronic EquipmentBusiness Interruption (Loss of Income) following damage to premises Select all that apply; we may require additional information depending on your answers below. Business Interruption Insurance (Loss of Income) This cover is primarily for loss of income following damage to or at the insured premise. Gross Freight Earnings / Turnover Additional Cost of Working Sum Insured Do you want cover for prevention of access to your premise where it has not been damaged? YesNo Consider if a factory fire nearby closed the street(s) to your depot, would this impact your business? Do you need cover for Damage to a Customer or Supplier's premise? YesNo Consider whether a fire or storm at a key customer/supplier might impact your ability to trade. Would you like cover to include loss of income resulting from your Motor Vehicles or Mobile Plant (such as forklifts) becoming damaged whilst parked up at this location? YesNo Do you have more than one customer or supplier who makes up more than 20% of your total GFE / Revenue / Turnover? YesNo Previous Next Business Public Liability General Liability - Limit of Indemnity Please select$5,000,000$10,000,000$20,000,000Other (specify below) What is your preferred Excess? Please select$0$250$500$1,000$2,500$5,000Other (specify below) Carriers Cargo Insurance This is cover for goods belonging to others whilst in transit or when loading and unloading during delivery. Do you use a Consignment Note or standard terms and conditions? NoYes Please attach a copy of your consignment note or standard terms Limit any one conveyance — What level of cover would you like? Please select your preferred type of cover: I'm not sure what I needLimited defined events cover (fire, flood, collision and overturning)Accidental Damage Cover What optional cover would you like included? Damage to Goods when Loading or UnloadingTheft, Pilferage or Non-Delivery of GoodsTemperature Controlled HaulageNominated Special ContractsShedding of LoadFreight Consequential Loss Select all that apply Transit (Own Cargo) Insurance This is cover for damage to goods belonging to you whilst in transit or during delivery. Customers’ goods are not covered here. What type of transits do you need cover for? Within AustraliaImportsExports Select all that apply What methods of transit do you use to send your goods? RoadPostRailAir FreightSea Freight Select all that apply What optional cover would you like included? Damage to Goods when Loading or UnloadingTheft, Pilferage or Non-Delivery of GoodsTemperature Controlled HaulageNominated Special ContractsShedding of LoadFreight Consequential Loss Select all that apply Cyber Crime Insurance Please list all Websites (Domains) that you operate your business from. We will provide you with a risk report for up to 4 that you list here along with a quote for Cyber Insurance. Website Website Website Website Cyber Risks Sum Insured If you are unsure, leave this blank and we will contact you to discuss an appropriate level for your business. Previous Next Insurance Claims History Have you had any claims during the past five (5) years, whether you were at fault or not, relating to the proposed insurance? NoYes Please provide details for each claim below or upload a Claims History document. Claim 1 Date of Claim Brief Description of Claim Insurer Amount of Claim What actions have you taken to prevent a similar issue from occurring again? Upload Claims History Document Are you aware of any circumstances or incidents which may give rise to a claim? NoYes Please provide details. Additional Information Please provide any additional information you would like to share with us relating to the proposed insurance. You may also attach any supporting documents below. Please sign and date any attachments. Additional Information Attachments Important Information Financial Service Guide (FSG) Our Financial Service Guide (FSG) explains who we are and the license under which we operate. You should read our FSG before accepting any policy or advice from us. You can read our FSG online at www.oraclegroup.com.au/fsg. Cooling Off If you are not completely satisfied with your policy, you may cancel it by notifying us in writing within 30 days of cover having commenced. You will receive a refund of the amount you have paid unless something has occurred for which a claim may become payable under the policy. Confirming Transactions You may contact us, in writing (which is always required if you are advising cancellation) or by phone, to confirm any transaction under your policy. Any transaction will be documented by us as quickly as possible. Code of Practice A self-regulatory Code of Practice exists for the general insurance industry, designed to raise overall standards. We have adopted the Code, details of which can be obtained from your insurance broker or our office. Complaints If you do not agree with any decision we make in relation to your insurance, please write to us stating what you disagree with and why. We will either resolve or attempt to resolve your complaint immediately or refer the matter to our Internal Dispute Resolution Committee (IDRC). If you are not satisfied with a claim decision by the IDRC, the matter may be referred to the Australian Financial Complaints Authority (AFCA) if it falls within their jurisdiction. Privacy We respect your privacy and comply with the Privacy Act and the National Principles. A copy of our Privacy policy is available upon request or on our website. Your duty when you apply for insurance Before you enter into an insurance contract, you have a duty to not misrepresent under the Insurance Contracts Act 1984. By law, you must take reasonable care not to make a misrepresentation. This means giving us true, complete and accurate answers to our questions, including where you provide information on someone else’s behalf. We use your answers to decide whether to insure you and on what terms. If you do not tell us something If any of your answers are misleading, incomplete, inaccurate or fraudulent we may reduce or not pay a claim, cancel your policy or treat it as if it never existed. Have you or any partner, principal, shareholder or director of the business ever been / had: Insurance declined, cancelled, renewal refused or special conditions imposed by an insurer? NoYes Declared bankrupt? NoYes Involved in a company or business which became insolvent or subject to any form of insolvency or voluntary administration (e.g. liquidation or receivership)? NoYes Convicted of any criminal offence within the past 5 years (other than minor traffic convictions)? NoYes Liable for any civil offence or pecuniary penalty exceeding $5,000? NoYes Are there any other matters that you should or would like to disclose? NoYes If you answered “Yes” to any of the above, please provide details: Declaration I hereby declare that: My attention has been drawn to the important notices accompanying this Application form and further I have read these notices carefully and acknowledge my understanding of their content by my signature below. The above statements are true, and I have not suppressed or mis-stated any facts and should any information given by me alter between the date of this Application form and the inception date of the insurance to which this Application relates I shall give immediate notice thereof. I authorise you to collect or disclose any personal information relating to this insurance to/from any other insurers or insurance reference service. Where I have provided information about another individual (for example, an employee, or client), I declare that the individual has been or will be made aware of that fact and the section in the Policy on “The way we handle your personal information”. I also confirm that the undersigned is authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this Application form and I complete this Application form on their behalf. 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