Car Insurance Quote

Max Insurances


D1, 27-29 William Pickering Drive,
Rosedale, 0632


Phone  0508 629 5626


Tel: 09 913 3011
Fax: 09 913 3012

Tell us a bit more and we will be in touch

Your Name

Date of Birth

Your Address

Contact Number

Your Email

Do you have existing car insurance


If you have, could you tell us the insurance company name and your customer & policy no.

Vehicle Use


If your vehicle is used for business purposes, could you tell us the business type




CC Rating

Registration No.

Value $

Alarm and/or Immobiliser


Parked in Locked Garage


Any Existing Damage or Defects


If your answer is 'yes' to previous question, please describe

Does your vehicle have non-factory fitted accessories valued over $1000 or modified in any way


If your answer is 'yes' to previous question, please detail

Is the vehicle on finance or lease


If your answer is 'yes' to previous question, what's the company

Who will be the main driver

What driving licence do you hold and how long have you held your licence for

Have you had any motor claims in the past 12 months


Any other relevant information that may affect the insurance cover

Declaration: I/WE HEREBY DECLARE AND WARRANT that the answers given above are in every respect true and correct, and that I/We have not withheld any information within My/Our knowledge likely to affect the decision of the Company as to My/Our eligibility for insurance. This request and declaration shall be the basis of the quote request.


All Finance Funds Ltd FSP 564207 - T/A Max Insurances NZBN (9429046167460) Providing Financial Products (General Insurance) as an agent of Insure247 Limited (FSP626729) NZBN (9429046774224). A disclosure statement is available, on request and free of charge.