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Tell us about your vehicle:

If your vehicle is more than 15 years old, contact us for help.

Tell us about your driving habits

The information you provide will help us determine your insurance needs
If you're unsure of the exact number, give it your best guess
1,000km 50,000km +100,000km

More information about commute distance.
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 0km10km20km30km40km50km60km70km

1234567

More information about kilometres driven for business.
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01,000km2,000km3,000km4,000km+5,000km

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 110203040506070

Years insured with your current provider

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What class of licence do you hold?

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What class of licence do you hold?

Have you completed a Driver's Training Course in the last 3 years?


Type of anti-theft device

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Are you an existing Co-operators Group Auto & Home client?

Bundling your insurance products may qualify you for additional discounts.

Any minor traffic tickets in the last three years?

More information about other driving offences.
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Any other driving convictions?

More information about other driving offences.
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Number of auto claims made in the past 10 years?

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Claim 1:
Type of claim

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 0 1 2 3 4 5 6 7 8 910

Claim 2:
Type of claim

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 0 1 2 3 4 5 6 7 8 910

Has your driver's licence been suspended in the last three years?


Occupation


Are you retired


Marital status


Years residing at your current address


When did you purchase this vehicle?

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