IMPORTANT: This Courier Application covers 4 insurance components:
    Complete this Courier Application form if you require insurance cover to commence. Contact our
    office separately if you are seeking a quotation only.

    Do you want to include?
    Comprehensive MVThird Party OnlyNot Required

    Do you want to include Public Liability insurance?
    YesNo

    Do you want to include Goods in Transit insurance?
    YesNo

    Do you want to include Personal Accident or Personal Accident & Sickness insurance?
    YesNo

    Insured Details


    Motor Vehicle Application

    Name of main driver

    Use above details

    Have you in the past 5 years:

    Name of Secondary driver

    Have you in the past 5 years:

    YesNo

    Public Liability Application

    Limit of Indemnity = $20,000,000

    Marine Transit Application

    Limit of any one carry = $200,000

    Personal Accident and Sickness Cover

    PLEASE TICK THE LEVEL OF COVER THAT YOU REQUIRE

    Accident cover is available up to 75 years of age, Sickness cover is only available up to 70 years of age. Any
    claims paid for accident or sickness will be paid based on 85% of your weekly earnings up to a maximum of the
    sum insured nominated

    C1
    CAPITAL BENEFIT
    WEEKLY ACCIDENT
    WEEKLY SICKNESS
    $50,000
    $500
    $500
    C2
    CAPITAL BENEFIT
    WEEKLY ACCIDENT
    WEEKLY SICKNESS
    $50,000
    $500
    NO COVER
    C3
    CAPITAL BENEFIT
    WEEKLY ACCIDENT
    WEEKLY SICKNESS
    $75,000
    $750
    $750
    C4
    CAPITAL BENEFIT
    WEEKLY ACCIDENT
    WEEKLY SICKNESS
    $75,000
    $750
    NO COVER
    C5
    CAPITAL BENEFIT
    WEEKLY ACCIDENT
    WEEKLY SICKNESS
    $100,000
    $1000
    $1000
    C6
    CAPITAL BENEFIT
    WEEKLY ACCIDENT
    WEEKLY SICKNESS
    $100,000
    $1000
    NO COVER
    C7
    CAPITAL BENEFIT
    WEEKLY ACCIDENT
    WEEKLY SICKNESS
    $125,000
    $1,250
    $1,250
    C8
    CAPITAL BENEFIT
    WEEKLY ACCIDENT
    WEEKLY SICKNESS
    $125,000
    $1,250
    NO COVER
    C9
    CAPITAL BENEFIT
    WEEKLY ACCIDENT
    WEEKLY SICKNESS
    $150,000
    $1,500
    $1,500
    C10
    CAPITAL BENEFIT
    WEEKLY ACCIDENT
    WEEKLY SICKNESS
    $150,000
    $1,500
    NO COVER

    Insurance and Medical History

    Duty of Disclosure

    Eligible contracts (private motor, strata, home, contents, travel, personal
    accident/disablement)

    If the insurer asks you questions that are relevant to their decision whether to insure you and on what
    terms, you are required to tell the insurer about anything you know and that a reasonable person in the
    circumstances would include in answering their questions.

    At renewal the insurer may give you a copy of anything you previously told them and ask you to advise
    them if that information has changed. If they do this, you must tell them about any change or tell them
    if there is no change. If you don't tell the insurer about a change, the insurer assumes there is no
    change to this information.

    This duty applies until the insurer agrees to insure you. You have the same duty before you renew,
    extend, vary or reinstate an insurance contract.

    All other contracts

    Before you enter into an insurance contract, you have a duty to tell the insurer anything that you know,
    or could reasonably be expected to know, that may affect their decision to insure you and on what terms.

    You have this duty until they agree to insure you. You have the same duty before you renew, extend, vary
    or reinstate an insurance contract. You do not need to tell the insurer anything that:

    • reduces the risk they insure you for;or
    • is common knowledge;or
    • they know or should know as an insurer;or
    • they waive your duty to tell them about.

    If you do not tell the insurer something

    If you don't tell the insurer something you are required to tell them, they
    may cancel your insurance contract or reduce the amount theywill pay you if you make a claim, or both.
    If your failure to tell them is fraudulent, they may refuse to pay a claim and treat the contract as if
    it never existed.


    Payment *

    By clicking here, I HEREBY DECLARE AND WARRANT that the answers given are in every respect true and correct and that I have not withheld information within my knowledge likely to affect the decision of the company as to my eligibility for insurance. I hereby agree that this Proposal and Declaration shall be the basis of the contract between the Company's Policy subject to the terms and conditions to be contained therein. I hereby declare that I have read the GSK Insurance Financial Services Guide.
    NOTE: I / We give consent to Graham Knight Insurance Brokers to disclose details of my / our Insurance Arrangements to the Courier Company I / We are contracted to. that the answers given are in every respect true and correct and that I have not withheld information within my knowledge likely to affect the decision of the company as to my eligibility for insurance. I hereby agree that this Proposal and Declaration shall be the basis of the contract between the Company's Policy subject to the terms and conditions to be contained therein.


    No Cover attaches until we have confirmed acceptance of cover to you in writing.

    Get a Free Quote Today!