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Make a claim
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Become a Taxicare member

Simply fill out this online application form and declaration to become a member of Taxicare. Our members enjoy reliable protection, priority servicing and advice from our experienced claims experts.

If you haven’t received a quote already, once we receive the forms we will be in contact with you within 24 hours during office hours.

Taxicare Member’s Application and Declaration form

Applicant Details

Vehicle Owner Name*(Required)

Date of birth*(Required)

DD slash MM slash YYYY

Address*(Required)

Suburb*(Required)

State*(Required)

Postcode*(Required)

Operator Name (if different)

Contact No.*(Required)

Email

Company/Business name (if applicable)

Company/Business Address (if applicable)

ABN

Taxi Vehicle Details

Vehicle Information

Registration Number*

Kilometers*

Year of Vehicle*

Vehicle Make*

Vehicle Model*

VIN / Engine No.

Click the plus icon to add a vehicle

Upload a copy of the current registration or renewal paperwork.

Upload a copy of the current registration

Max. file size: 300 MB.

Is the car financed?*(Required)

Is the car financed?*

Yes

No

Is the car financed, if YES, by whom?*(Required)

How many years have you been driving taxis?*(Required)

How many years have you owned a taxi?*(Required)

Is Personal Accident (PA) cover required? (QLD and NT only)*(Required)

Yes

No

We/I agree to the policy wording of the <a href="https://taxicare.com.au/wp-content/uploads/2025/03/Blend-Group-Personal-Accident-Sickness-Insurance-effective-1-st-May-2021.pdf" target="_blank" rel="noopener noreferrer">Blend (PA) Product Disclosure Statement</a>.*(Required)

We/I agree to the policy wording of the Blend (PA) Product Disclosure Statement.*

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Applicants Declaration

We/I agree to abide by guidelines of Taxicare Australia's <a href="https://taxicare.com.au/wp-content/uploads/2025/03/Taxicare-Australia-PDS-June-2022.pdf" target="_blank">Product Disclosure Statement</a>.*(Required)

We/I agree to abide by guidelines of Taxicare Australia’s Product Disclosure Statement.*

We/I understand that the benefits and covers offered under this agreement are at the Board’s discretion and are contingent upon the truthfulness of this declaration and accordingly. We/I have not withheld any information that may affect the acceptance of this application or be regarded as reckless or unacceptable to the taxi industry.*(Required)

We/I understand that the benefits and covers offered under this agreement are at the Board’s discretion and are contingent upon the truthfulness of this declaration and accordingly. We/I have not withheld any information that may affect the acceptance of this application or be regarded as reckless or unacceptable to the taxi industry.*

Date cover is to commence*(Required)

DD slash MM slash YYYY

Applicant's Name*(Required)

Applicant's Signature*(Required)

(Draw your signature above)

Today's Date*(Required)

DD slash MM slash YYYY

ASR Application

Details

Period of Cover Form*(Required)

Period of Cover Form*

DD slash MM slash YYYY

Period of Cover To*(Required)

Period of Cover To*

DD slash MM slash YYYY

Insured Name*(Required)

Address*(Required)

Suburb*(Required)

State*(Required)

Postcode*(Required)

Phone*(Required)

Email

Taxi Registration*(Required)

Taxi State of Operation*(Required)

Taxi Area of Operation*(Required)

City

Suburban

Rural

Small Business exemption (NSW only)

NSW Stamp Duty Exemption – Small Business Declaration

This declaration only covers policies for the financial year in which the cover is affected or renewed. I hereby declare that I am a Capital Gains Tax small business entity (within the meaning of section 152-10 (1AA) of the Income Tax Assessment Act 1997 of the Commonwealth). I am a small business individual/partnership/company and/or trust, which is carrying on a business, and the business has an aggregated turnover of less that $2 million.

Please download the NSW Stamp Duty Exemption – Small Business Declaration form from here fill in your details and upload below.

Note: You will need to download the form to be able to sign it digitally if your computer has this available on your computer, alternatively please print and sign the form and send us a copy to: admin@taxicare.com.au otherwise upload a copy below.

NSW Stamp Duty Exemption – Small Business Declaration form

Upload a copy of your NSW Stamp Duty Exemption – Small Business Declaration form

Max. file size: 300 MB.

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Cover Required

Is Public Liability (PL) Cover Required?*(Required)

Yes

No

We/I agree to the policy wording of the ASR PL Policy Wording.*(Required)

We/I agree to the policy wording of the ASR PL Policy Wording.*

Limit of Indemnity Required?*(Required)

$10,000,000

$20,000,000

Is Third Party Propery Liability Required? (Limit $20,000,000)*(Required)

Yes

No

We/I agree to the policy wording of the ASR Third Party Policy Wording*(Required)

We/I agree to the policy wording of the ASR Third Party Policy Wording.*

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Vehicle Information

Vehicle Information(Required)

Registration Number*

Registered State*

Year*

Make*

Model*

Click the plus icon to add a vehicle

Section Break

History

Have you had any claims, incident/s or accident/s occur in the past 5 years which would have been covered by the proposed Insurance Policy/ies.*(Required)

Yes

No

If "Yes" please provide details:

Do you have a Claims History from your current insurer?

Yes

No

Upload your Claims History

Upload your Claims History

Max. file size: 300 MB.

Have you had any insurance declined or cancelled, Proposal rejected, Renewal refused, Claim rejected, or Special Conditions imposed by an insurer?*(Required)

Yes

No

If "Yes' please provide details:

Name of Signatory*(Required)

Insured's Signature*(Required)

Position*(Required)

Dated*(Required)

DD slash MM slash YYYY

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Name

This field is for validation purposes and should be left unchanged.

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* Insurance provided by an Australian Prudential Regulatory Authority (APRA) Insurer.
^ Once approved by the finance company.