Date :	20/11/2008
	Loss of Licence in last 5 years :	Select One --> Yes No
	Please provide details :
	DUI / PCA Conviction :	Select One --> Yes No
	Please provide details :
	2 or more "At Fault" accidents in last 4 years :	Select One --> Yes No
	Please provide details :

Premium Calculator
Type of Vehicle		Select One --> Standard Sedan/Ute 4WD (2.5L & Up) Prestige or European High Performance		Excess $
State		Select One --> ACT NSW NT QLD SA TAS VIC WA		* No under 21 year old Drivers
District		Select One --> Metro Country
Estimated Market Value	$			* If no Tracking System, Excess will be $3,000 for Theft of Vehicle
				* If under 25, stated premium must be loaded by 33.33%
Annual Premium	$
FSL	$
GST	$
Stamp Duty	$
Sub-Total	$
Plus Broker Fee	$	88.00
Equals All-Up Premium	$
* PLEASE NOTE: Your quote will be referred to Austcover