Get a Motor Vehicle Insurance Quote

Title

Miss
Master
Ms
Mrs
Mr
Doctor

Full name

Have you completed an estimate for this vehicle using our online estimator tool?

If you happen to know your Estimate ID, please enter it here:

I am already a MAS Member

Yes
No

Please tick this box to confirm you've read and understood the terms and conditions that apply to temporary cover for your vehicle:

I understand

Member number

Email

Phone number

What's the best time of day to contact you?

Morning (9am - 12pm)
Afternoon (12pm - 5pm)

Street

City

Postcode

Date of birth

Occupation

I am the registered owner

Yes
No

Full name and postal address of the registered owner/the insured

Have you been affected by any recent weather events or disasters?

Yes
No

Please provide more information about how this weather event/s affected you.

I wish to insure the vehicle from

Please note that we are unable to issue an insurance policy for a past date, and if you require insurance to start in the next three business days, please call us on 0800 800 627.

Does this vehicle replace a vehicle currently insured with MAS?

Yes
No

If yes, please provide the policy number

Registration number

Year

Make and Model

Is this an electric or hybrid vehicle?

Yes
No

What address will the vehicle usually be at overnight?

Which cover type do you require?

Comprehensive
Third party only
Third party, fire and theft
Fire and theft only

Estimated vehicle value

Please indicate a sum

Do you wish to add hire car coverage?

If your car is off the road due to a claim, we will cover the costs for you to hire a car. Please see policy wording for full details.

Yes
No

Is the vehicle used in connection with any trade or business?

Yes
No

If yes, please provide full details

Is the vehicle subject to any financial interest by any other party?

Yes
No

If yes, who is the finance with?

Which of the following security devices are installed?

Alarm
Immobiliser
Steering Wheel Lock
None

If you ticked 'other', please describe the modifications here:

If your vehicle has accessories, please list the value of the these (e.g. Spoiler $100, Aftermarket stereo $10,000). If 'other' please also describe the accessories here:

Who is authorised to drive this vehicle?

Any driver
Any driver excluding under 25s
Named drivers only

Who will be the main driver of the vehicle?

Main Driver: Title

Miss
Master
Ms
Mrs
Mr
Doctor

Main Driver: Full name

Main Driver: Date of birth

Main Driver: Occupation

Main Driver: Licence Type

(full, restricted, learner)

Main Driver: Country of issue

E.g. New Zealand

Main Driver: Years held

Main Driver: Relationship to Member

Main Driver: Home Address

Do you want to add a second driver?

Yes
No

Driver 2: Title

Miss
Master
Ms
Mrs
Mr
Doctor

Driver 2: Full name

Driver 2: Date of birth

Driver 2: Occupation

Driver 2: Licence type

(full, restricted, learner)

Driver 2: Country of issue

E.g. New Zealand

Driver 2: Years held

Driver 2: Relationship to Member

Driver 2: Home Address

Do you wish to add a third driver?

Yes
No

Driver 3: Title

Miss
Master
Ms
Mrs
Mr
Doctor

Driver 3: Full name

Driver 3: Date of birth

Driver 3: Occupation

Driver 3: Licence type

(full, restricted, learner)

Driver 3: Country of issue

E.g. New Zealand

Driver 3: Years held

Driver 3: Relationship to Member

Driver 3: Home Address

Do you wish to add a fourth driver?

Yes
No

Driver 4: Title

Miss
Master
Ms
Mrs
Mr
Doctor

Driver 4: Full name

Driver 4: Date of birth

Driver 4: Occupation

Driver 4: Licence type

(full, restricted, learner)

Driver 4: Country of issue

E.g. New Zealand

Driver 4: Years held

Driver 4: Relationship to Member

Driver 4: Home Address

Do you want to add a fifth driver?

Yes
No

Driver 5: Title

Miss
Master
Ms
Mrs
Mr
Doctor

Driver 5: Full name

Driver 5: Date of birth

Driver 5: Occupation

Driver 5: Licence type

(full, restricted, learner)

Driver 5: Country of issue

E.g. New Zealand

Driver 5: Years held

Driver 5: Relationship to Member

Driver 5: Home Address

1. been convicted of any driving offence or has any prosecution pending?

(you can ignore parking offences)

Yes
No

Please provide full details including conviction, year and fine

2. incurred any speeding or speed camera fines?

Yes
No

In the last five years how many speeding or speed camera infringements have occurred?

Please provide full details including driver name, infringement, year and fine

Have any of these infringements resulted in a loss of licence?

Yes
No

3. had an accident or loss in connection with a motor vehicle, whether or not a claim has been made?

Yes
No

Please provide as many details as you can, including conviction, year and fine.

Have you or anyone else to be covered by this insurance, ever engaged in any criminal activity, had any criminal convictions or have any criminal prosecutions pending?

This information is sought subject to the rights set out in the Criminal Records (Clean Slate) Act 2004.

Yes
No

If yes, please tell us more about this (including conviction, sentence and year)

Have you held motor vehicle insurance with any other insurer in the last 12 months?

Yes
No

If yes, please provide the company name and the policy number.

In the last five years have you, or anyone else to be covered by this insurance, suffered any loss or damage to your motor vehicle, including theft, malicious damage or burglary (regardless whether an insurance claim was made)?

Yes
No

Please provide full details including description, year and cost.

Have you ever had any insurer decline cover, impose special terms or refuse renewal of any policy?

Yes
No

If this has happened, please provide full details.

Do you or anyone else to be covered by this insurance have a medical condition that may affect your driving ability?

Yes
No

If yes, please provide further details.

Is there any further information likely to affect this insurance?

Yes
No

If yes, please elaborate.

If you accept your quote, how would you like to pay the premium for your policy?

Direct Debit
Internet banking (annual lump sum)
Credit card (annual lump sum)

Please select your Direct Debit payment frequency:

You can pay your premiums annually, six-monthly, quarterly or monthly. Six-monthly payments include a 3% payment administration fee and quarterly or monthly payments include a 6% fee.

Annually
Six-monthly
Quarterly
Monthly

Please tick this box to confirm you've read and understood the declaration above

Do you want to add a voluntary excess?

Yes
No

Voluntary excess required

Note: Voluntary excesses apply in addition to the standard policy excess, but do not apply to glass or locks and key claims.

$200
$500
$1,000
$2,000

How did you hear about MAS?

Google (or any other search engine)
Family/Existing Member referral
Social Media
Radio
Print
Word of mouth
Join the Conversation (our student newsletter)
Other

You selected 'Family/Existing Member referral', please enter the full name of your referrer here.

You selected 'Other', please let us know how you heard about us.

One last question: Are you applying for other insurance quotes from MAS?

Yes
No

Please advise what other insurance quotes you are applying for.

House
Contents

Get a Motor Vehicle Insurance Quote

If you'd like to receive a quote for your car, motorbike or trailer, please fill in the form below.

Postal address

Insured vehicle

We will now require you to enter a couple of details for all drivers of the vehicle.

In the last five years has the principal driver or any other person who is likely to have the use of the insured vehicle:

Previous insurance and criminal convictions

Disclosure of relevant information

Privacy Act 2020

Voluntary Excess