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Amendment
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*Member Name
*Membership Number
Cab Number
Vin Number
*T Plate
*EFFECTIVE DATE:
Type of Amendment
--- Select ---
1. Change of Plates
2. Change of Member Details
3. Cancellation
4. Change of Ownership
5. Replacement Vehicle
6. Additional Vehicle
-----------------------------------------------------
Your Amendment Detail
*New T Plates
*Phone Number
*Email
New Address
New Account Number
New Account BSB
New Account Name
New Owner Name
New Owners ABN
New Phone Number
Cancellation Reason
--- Select ---
Decommissioned
No Longer Required
Business sold
Not Renewing
Insured Elsewhere
Sold Vehicle
Customer Service
Other
Describe Reasons in detail if any
Year
Make
Model
Body
Colour
Vin
Registered Owner
Registered Owner ABN
Level of Cover
--- Select ---
TPPD
Comprehensive
Public Liability
Personal Accident
Is the vehicle under finance?
--- Select ---
Yes
No
If Yes, Who is the finanicer ?
Excess Amount
--- Select ---
$1,000.00
$2,000.00
$3,000.00
$4,000.00
$5,000.00
$10,000.00
$15,000.00
Other_________
Other Amount of Excess
Signature
Submit Amendment
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