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Please complete and return the following form together with claims history for at least last 3 year on underwriters letterhead via email support@colonialinsurance.com.au or fax it to 02 9683 1775

Period of Insurance

(at 4.00pm local standard time)

Insured

The Vehicle

Underwriting Information

General Advice on this website has been prepared without taking into account your objectives, financial situation or needs. Before acting on advice, consider its appropriateness. Consider our disclosure documents, which include our FSG and Product disclosure Statements (PDS) for some products.