Tasman Insurance Brokers

Motorcycle Application

Contact Information

Bike Information

Declaration

If you answer yes to any of the questions below, please provide more information.

Note: All bikes must carry/be fitted with an approved fire extinguisher for any forest riding, compliant spark arrester and valid WOF/Service check

Your Duty of Disclosure

You must tell us everything you know (or could be reasonably expected to know) that a prudent insurer would want to take into account in deciding a) whether to accept your proposal and b) if so, on what terms. Examples of what you must tell us include: a) anything that increases the risk of a claim b) any criminal offending or convictions c) any previous insurance claims that cannot be withheld under the Criminal records (Clean Slate) Act 2004 d) any refusal by another insurance to insure you on standard terms, or continue to insure you on standard terms. You have this duty every time this policy renews, or when you request any changes to it. If you fail to do this, we may avoid the policy retrospectively. You will have no insurance at all. When in doubt, disclose.

Change of circumstances

You must tell us of any material changes in your circumstances after the policy starts or during the currency of the cover and/or after any renewal.

Declaration

To be completed by the insured(s) shown and also on behalf of any other person covered by these insurances. 1. I/We declare that all information contained in this form and on any attachments are complete and correct. 2. I/We have disclosed all information relevant to the acceptance of the proposal, including all information as noted in ‘Your Duty of Disclosure’. 3. I/We agree that this proposal shall be the basis of the contract between me/us and Star Underwriting Agents Ltd and Vero Insurance NZ Ltd and I/We am/are willing to accept the terms, conditions and exclusions for this insurance contract. 4. The market value of the motorcycle means the price You paid for the vehicle or the cost of replacing the vehicle in New Zealand whichever is the lesser amount, with one of the same make, model, specification, mileage, age and condition. 5. I/We understand that this proposal requests information about me/us which is held by the intended recipients – Star Underwriting Agents Ltd, PO Box 97-954, Manukau City, Auckland 2241 and Vero Insurance NZ Ltd, Private Bag 92 120, Auckland to evaluate my application for insurance and service my policy. Failure to provide the information sought may result in my/our application being declined and my/our insurance being void from the beginning. 6. I/We authorise Star Underwriting Agents Ltd and Vero Insurance NZ Ltd to; a. Exchange information with other insurers, financial institutions who have any interest in the property insured, and the Insurance Claims Register, PO Box 474, Wellington, to assess my/our application for insurance and to place information of the Insurance Claims register which other insurers can access; b. Give to or obtain personal information from any party any information relating to this insurance or any other insurance held by me/us or any claim made by me/us.. 7. I/We understand that there are rights of access to and correction of information held by Star Underwriting Agents Ltd, Vero Insurance NZ Ltd, and the Insurance Claims Register. 8. Star Underwriting Agents Ltd act as agents of Vero Insurance New Zealand Ltd not as your agent. The policy is underwritten by Vero Insurance New Zealand Ltd and references above to “us” means Star Underwriting Agents Ltd and Vero Insurance New Zealand Ltd.

Any forestry/trail riding cover must comply with all Insurer requirements. (All bikes must carry a fire extinguisher, compliant spark arrester and valid WOF/Service check)

Contact

63 Trafalgar Street
Nelson, New Zealand

FSP386146

Claire Hughes

Assured Domestic Broker

027 456 1494

Karen Botica

Tasman Insurance Brokers

027 456 1494karen@tibrokers.co.nz

Straight-forward insurance for all Kiwis, we’re here for you!

Straight-forward insurance for all Kiwis, we’re here for you!