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Ulysses CTP Greenslips

Personal Details
 * Name
  Ulysses Member Number
*Date of Birth
 * Garaging Address
 * Postcode
 * Contact Phone
 * Email
*As the registered operator of the vehicle how many demerit points have you accumulated on your NSW Licence
After Hours Phone
Mobile Phone
 * All fields marked with an asterisk are required to be filled in
Motorcyle Information
*Engine Size AS per Rego
*Year of Manufacture
Expiry Date of Current CTP Greeslip
*Current Expiry Date
Pick Date from Calendar Select
Please note: If this form fails to send because of missing information, you will need to re-select YES for each of the following statements when you correct the other missing information. If any information is missed it will be displayed at the top of your screen.
Privacy Statement
*Please Indicate your Acceptance of our Privacy Statement by selecting YES below.

We use the information you give us to provide the quote, consider any application for cover and where cover is issued, to manage and administer your and our rights under the policy. For example, the handling or settlement of claims. To do this we may provide it to third parties such as other insurers, reinsurers, loss adjusters, external claims data collectors, investigators and agents or other parties as required by law. Where you provide us with information about other persons you must have their consent to this and provide it on their behalf. If not you must tell us. We handle it in accordance with the Privacy Act 1988. To access or change the information just call us.

Duty of Disclosure
*Please Indicate your Acceptance of our Duty of Disclousre by selecting YES below.

Under the law we are required to inform you about your duty of disclosure. When quoting we will be asking various questions of you. You have a duty at law when answering them to give us honest and complete answers, and tell us everything you know and that a reasonable person in the circumstances could be expected to tell us. You answer the questions for yourself and everyone else covered by the policy, because you apply on their behalf and with their consent. If you breach the duty the Insurer may cancel the policy or reduce the amount we pay for a claim. If fraud is involved, they may treat the policy as if it never existed and pay nothing. If you agree you consent to answering these questions and to the collection, storage, use and disclosure of this information. Product Disclosure Statement Compulsory Third Party Insurance (NSW CTP) A green slip is an insurance policy, which provides cover for compulsory third party (CTP) personal injury insurance. CTP Insurance provides compensation for other people injured in an accident when you or the person driving your vehicle is the driver at fault. The CTP Greenslip does not cover any costs of repairs to vehicles. By law, every person who owns a motor vehicle requiring registration in NSW must have CTP Insurance. The NSW Government exercises control over this insurance through the Motor Accidents Authority (MAA) and the Motor Accidents Compensation Act (MACA) 1999 (as amended). The NSW Government has granted Allianz Australia Insurance Limited and Allianz Insurance Limited licences to write CTP Insurance for NSW registered vehicles. Allianz Australia and Allianz offer competitive premiums for all classes of vehicles. Our strategic alliances include Motor Dealers, Financial Institutions, Fleet Leasing Companies and Insurance Brokers.