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Joining My Rideshare Cover membership is easy and offers numerous benefits. Simply fill out the form below with all necessary details and submit. Our consultants will reach out to you shortly to guide you through the entire process.

As a member of My Rideshare Cover, you can enjoy rideshare cover, expert guidance, and fast claim settlement while we take care of everything for you. Don’t worry about your car again, complete the online application process and experience these remarkable benefits

Personal Details

Membership Start Date

I am

Full Name

Do you want this policy under a personal or company name?

Date of Birth

Driving Licence Number

Licence Expiry

Licence issues in

ABN Number

Driver Accreditation Number

Full Address

Mobile Number

Email Address

Vehicle Details

Rego

Year

Make

Model

VIN

Odometer

How many kilometres does your car travel on average each year?

Location where's the vehicle usually kept?

Name of Financer

Color

Body Type

Engine Number

Purchase Price

Registered Owner Name

Additional Services

Enter the Payment Details

Card Number

Month

Year

CVC

Payment Authorisation Consent

I hereby authorise My Rideshare Cover to charge my card, using the information I provide upon payment for the membership. I understand that My Rideshare Cover may further charge my card for any unpaid or overdue balances.
I acknowledge that the information shall be processed through the Stripe Payment Gateway who shall be charging my account for the purchases I made. I understand that financial information shall be stored with Stripe for future transaction reference for any payment processes that shall be made through the payment gateway facility.

Consent

By providing the email address for the contact person, you agree that this email address is the default address for all member correspondence (such as transaction confirmations, statements, reports and other material) and you agree to the Terms for Electronic Communication outlined on our website at www.myridesharecover.com or available on request from Member Services. From time to time we may still send you correspondence in the post

*** If you’re having trouble submitting the form, please make sure you’ve enter all the required form details.

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