Insurance Cover *

Comprehensive Cover
Third Party Only Cover
Third Party, Fire, Theft and Transit Cover
Tyre & Rim Cover

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Phone

Bike Manufacturer *

Bike Model *

Bike Year Model *

Value to Insure *

Date of Birth *

Gender *

Consecutive Years Motorcycle licence held *

If less than 1 year please put 0

Storage Method *

Will there be any OTHER rider under the age of 25 using the vehicle? *

Yes
No

In the last 5 years have the following applied to you?

In the last 5 years had any insurance refused or cancelled? *

Yes
No

In the last 5 years suffered any motorcycle or theft insurance claims? *

Yes
No

In the last 5 years been charged of convicted of any offence (other than vehicle/motorcycle offences) *

Yes
No

In the last 5 years ever had your motor vehicle or motorcycle license suspended or revoked for any reason? *

Yes
No

If answered "Yes" to any of the above, please give a brief description of when/ date and how it happened.

Privacy Policy

By ticking the box you you agree that you have read and agree to YMI’s Privacy Policy. We value your privacy and have a Privacy Statement telling you about how we handle personal information collected for this insurance. We will send it with your quote; However, you can read it now if you want. Privacy Policy. You also agree that Trooper Lu’s Garage will use your information for marketing

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In the last 5 years have the following applied to you?

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