| (a) |
Your
full name |
| (b) |
Your
full home address including
postal code (necessary for
quoting purposes only) |
| (c) |
Your
contact phone number |
| (d) |
Your
date of birth and
your age at the REQUIRED POINT
OF INSURANCE |
| (e) |
Your Motorcycle
License level? (
M1, M2, M ), and the date(s)
EACH LEVEL reached.
Also, the date of completion
of any approved
Motorcycle Safety Training
Course
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Note
for Ontario Riders:
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| (f) |
The
intended use of the vehicle
(on or off-road). If 'on-road',
please indicate the primary
use (pleasure or commute)
This does not necessarily
affect the rate but is required
and commuters should indicate
the one-way distance of a
regular commute.
Commercial
/Business and 'motorcross'
use is not covered.
However, trailriding/dirtbike
riding is acceptable
|
| (g) |
Any
prior motorcycle insurance?
- please advise which Insurance
Company
- indicate if such cover was
cancelled for non-payment
or failure to disclose relevant
information |
| (h) |
Any
'moving violations' or 'at-fault'
accidents within the last
36 months. |
| (i) |
The
description of your motorcycle/scooter:
YEAR; manufacturer; model;
c.c. size AND IT'S VALUE (including
any options). Include the
value of any sidecar.
The total value must be declared
for all quotes
Bike
over 15 years old and "Physical
damage" cover needed
in addition to Liability?
|
| (j) |
Do
you have Sherlock
Anti-Theft security
engravings OR the Harley-Davidson
Factory Security System /
Gorilla or Viper
Motorcycle Alarm on
your machine?
For
Harley's & Indian Chiefs,
security systems DETER thieves
and REDUCE the DEDUCTIBLES
for Comprehensive /Specified
Perils to $1000 (applies
to these machines only),
Collision deductible on
these motorcycles are 10%
of declared value of bike.
Contact your dealer for
further details.
***
SPORTS AND TURBO-CHARGED
MOTORCYCLES ***
Certain
sports motorcycles manufactured
AFTER 1984 are surcharged.
The surcharge varies depending
upon the age and driving
record of the rider.
|
| (k) |
The
coverage you require
: either Third
Party Liability only (offered
at a standard $1M level as
the cost is one of the cheapest
parts of the premium total)
or
with additional Physical
Damage Coverages:
You
can choose ANY of
below, but you would take
either Comprehensive
or Specified
Perils (NOT BOTH). You may
choose DEDUCTIBLES (for
example at $300, $500, $750,
$1000 or above).
Do
you require Collision
cover? (Please state
desired level of DEDUCTIBLE)
Do
you also require Comprehensive
cover? (Please state
desired level of DEDUCTIBLE)
or Specified Perils
which is fire &
theft only and CHEAPER
than 'Comprehensive' ( Please
state desired level of DEDUCTIBLE
)
***
IMPORTANT NOTE ***
Comprehensive,
or 'fire & theft'
cover (Specified Perils)
is never
sold without Third Party
Liability, on a 'single
bike' policy. Comprehensive
or Specified Perils may
be given for one or more
bikes, provided
that at least
ONE bike on the policy
has Third Party Liability
cover.
|
| (l) |
Payment
Plans
Do
you require a payment plan?
(current arrangements require
a 3% service charge for
installments with a 25%
down payment (VISA or MasterCard
may be used for down payment)
& the respective balance
being paid over THREE successive
months in equal installments
by debit from a chequing
account). Premiums
are also currently subject
to 1% Sales Tax (no
tax from 1 April 2004).
VISA
or MasterCard may be used
for Full-payment policies
!
ALL
our quotes include
'Family Protection' endorsement
#44 unless you specifically
request omission.
|
| (m) |
All
of our clients
qualify for Group Discount
Rates!
We'll gladly advise
on discount group memberships
for you for MAXIMUM
SAVINGS! |
| (n) |
Which
Insurance Company currently
covers you for auto/home insurance
and when are your policies
due for renewal?
We'll
be delighted to give you
the best quotes possible
and target Maximum Savings
for you!
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