Yamaha Insurance Application

First Name
Surname
Address
Suburb
Postcode
Home Phone
Mobile Phone
Email
Date of birth
Gender of rider
Consecutive years motorcycle license held
Make
Model
Year
Registration Number
Marker Value
Will this unit be road registered?
Excess
Third party cover will have $500 excess
   
Storage postcode
State area
Storage method
No claim benefit category
Has the insured(s) in the last 3 years had any insurance refused or cancelled?    
Has the insured(s) in the last 3 years been charged of convicted of any offence (other than vehicle/motorcycle offences)?    
Has the insured(s) in the last 3 years ever had their motor vehicle or motorcycle license suspended or revoked for any reason?    
Do you hold a current/valid Australian Motorcycle License?    
Is the Motorcycle used for any business/ commercial use?    

Yamaha GAP Insurance, Loan Protection Insurance and Tyre and Rim Insurance issued prior to 31 October 2017 (Product Disclosure Statements) and Yamaha Motorcycle Road Insurance, Off Road Rider Insurance and Yamaha Marine Insurance and Marine Water Vehicle Insurance issued prior to 22 November 2017 (Product Disclosure Statements) are underwritten by AIG Australia Limited ABN 93 004 727 753 AFSL 318686 (AIG) acting through its agent NM Insurance Pty Ltd (ABN 34 100 633 038) (AFSL 227186) (NM Insurance). About NM Insurance: NM Insurance acts under a binder authority from AIG, which allows NM Insurance to arrange this insurance, to administer it and to handle and settle claims made upon it, subject to the terms of the binder authority. In doing so NM Insurance acts for AIG and not You. NM Insurance's Australian Financial Services Licence authorises it to provide these services. NM Insurance’s contact details are: NM Insurance Pty Ltd, 28-32 George Street, Sandringham VICTORIA 3191 Telephone: 1300 794 454 Facsimile: 03 8599 5099 Email: customerservice@nminsurance.com.au.


From 1 November 2017, Yamaha GAP Insurance, Loan Protection Insurance and Tyre and Rim Insurance and from November 22 2017, Yamaha Motorcycle Road Insurance, Off Road Rider Insurance and Yamaha Marine Insurance and Marine Water Vehicle Insurance are underwritten by HDI Global Speciality SE – Australian Branch ABN 58 129 395 544, AFSL No. 458776 (HDI Global Speciality) acting through its agent Yamaha Motor Insurance Australia Pty. Ltd. ABN 48 603 882 980, AFSL 497198 (YMI). Please read the Product Disclosure Statements (PDS).


Any advice provided is of a general nature only and does not take into account your particular objectives, financial situations or needs. Please read the Product Disclosure Statements (PDS) before You make any decisions regarding this product. If You have any queries that are not covered in the PDS, please contact Your local Yamaha dealer. YMI acts under a binder authority from Inter Hannover as the Insurer that allows YMI to arrange insurance policies and to handle and settle claims made upon it subject to the terms of the binder authority. In doing so YMI acts for Inter Hannover and not You. YMI’s AFSL authorises it to provide these services. YMI’s contact details are: Yamaha Motor Insurance Australia Pty. Ltd. Level 5, 50 Berry Street North Sydney NSW 2060 Telephone: 1300 794 454 Email: Customerservice@ymia.com.au

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Off road rider insurance
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