Completing this online Proposal Form

Please answer all questions giving full and complete answers.
It is the duty of the proposer to provide all information that is requested in this Proposal Form as well as to disclose relevant facts. A relevant fact is a known fact or circumstances that may influence the evaluation of risk by the insurer. If you are uncertain about what a relevant fact is, please contact us.
If renewing an existing policy with Fenton Green, please ensure you check all information and make any necessary changes.

Business Details

Income Details

Total Annual Income

Professional Services

Total must be 100%:

Motor Vehicle Driving Instructor / Assessor (Sedan)

Truck Driving Instructor / Assessor (less than 10 ton)

Truck Driving Instructor / Assessor (greater than 10 ton)

Motorcycle Driving Instructor / Assessor

Off Road 4WD Driving Instructor / Assessor

Bus Driving Instructor / Assessor

Unregistered Vehicle Driving Instructor / Assessor

Other

Please describe the Other Professional Services you provide:

Number of Driving Instructors Requiring Cover under this policy

State

Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?

Yes No

Period of Insurance

Policy Start Date