Let us give you a free, no obligation quote now on your car. Simply complete all the questions on this online form, press the submit button and your quote request will be emailed to us. Even if you existing policy isn’t up for renewal yet, ask for a quote now and we’ll guarantee our quote for the next 12 months.
 
Member Information 1
Title Mr Mrs Miss Ms
Surname   Given Names
Date of Birth      
Member Information 2
Title Mr Mrs Miss Ms
Surname   Given Names
Date of Birth      
Contact Details
Address   Suburb
Email   State/Postcode
Phone   Mobile
 
Vehicle Information
Make of Car   Full model description
Year of Manufacture   Automatic or manual
Engine size   Type of body
Your current no claim bonus rating   Age of youngest regular driver
 
Where is the car normally kept overnight?
carport garage on your property on the street
 
Is the car fitted with an anti-theft device?
Yes No
 
Has the vehicle been modified?
Yes No
 
Is the car financed?
Yes No
 
Have any of the drivers lost their licence or had their licence suspended?
Yes No
 
How many accidents have you had in the past 5 years?
Approx. annual kilometres   Expiry date of current policy
Current Insurer   Current Premium $
 
Comprehensive agreed value Estimated value $
Third party property damage only Please specify sum insured $
 
 
Permitted Use - Your Shannons Policy only covers your car while it is being used for personal or domestic purposes. You can use it in connection with your occupation or business providing they are not any of the following: commercial traveller, courier, insurance agent or broker, real estate agent, driving instructor, stock or station agent, taxi or hire car driver, testing or demonstration of motor vehicles, towing of motor vehicles.
 
This insurance product is issued by Australian Alliance Insurance Company Limited ABN 11 006 471 709 Australian Financial Services Licence No 235011. You can get a Product Disclosure Statement (PDS) by phoning 13 46 46, from any of our branches or by clicking here. You should consider the Product Disclosure Statement in deciding to buy or hold this insurance product. Shannons Limited ABN 91 099 692 636 Authorised Representative No 239594. You can view our Privacy Statement and PDS here. Note: As no conversation was conducted, no personal advice was given.