Application

Please read the following documents before proceeding with your application:

Policy Wording, Product Disclosure Statement and Financial Services Guide.

Policies as subject to the following conditions:

This policy does not cover your bike/kart whilst in use.
Your bike/kart must be secured with a lock and chain to a fixed object at all times when not in use.
Your bike/kart must be stored within a fully locked and enclosed building when kept at the garaging address.
If you have had any criminal convictions or motor related theft claims in the past five (5) years, please ring 1300 655 931 during normal office hours for a quote.
If you have had an insurance policy declined, cancelled or a renewal refused in the past five (5) years, please call 1300 655 931 during normal office hours for a quote.

Confirmation

I confirm that I have read and received the Policy Wording, Product Disclosure Statement and Financial Services Guide contained herein and that, to the best of my knowledge, the information I have provided is true and hereby apply for cover under the JLT Dirt Bike Insurance policy based on the information I have provided on this Application Form.

I understand that: This policy does not cover your bike/kart whilst in use; my bike/kart must be secured with a lock and chain to a fixed object at all times when not in use; and my bike/kart must be stored within a fully locked and enclosed building when kept at the garaging address.

Yes No

Online applications must be paid by credit card (Visa or Mastercard). For cheque or money order, please download the application form. Please call us on 1300 655 931 if you would like to arrange Pay By the Month or any other method of payment.