Public Liability Insurance for cleaners by Liability Brokers

Public Liability Insurance for Cleaning Contractors

Due to the variety of Cleaning Services, we need you to complete this form so that we can get the best quote for you.

Providing you are not involved in the high risk areas, you will receive a confirmed quote on the same business day or the next business day if received after hours.

If you would prefer to talk to a broker first, please call Liability Brokers 1300-881-779 between 8.15am and 5.15pm E.S.T. business days and receive an indicative quote over the phone.

Insured Name:
Trading Name:
ABN No.(if applicable):
Street Address:
Suburb or town:	Postcode:
Email Address:
Telephone No:
Start date of business:

Occupation - Cleaning Contractor

This policy is for Cleaning Contractors only. If you perform other duties that are not normally defined as cleaning contract work, please give full details:

Please supply a split of your work activities as a percentage
Must add up to 100%
Carpet Cleaning		%
Chimney Cleaning		%
Construction Sites - Clean up after builders		%
Curtain Cleaning		%
House Cleaning		%
Office Cleaning		%
Shop Cleaning (Internal)		%
Shopping Centres (common areas)		%
Supermarkets		%
External Window Cleaning - under 6 metres		%
External Window Cleaning - over 6 metres		%
Other		%

If you have placed a percentage amount in "Other" above, please give full details:

Is cleaning performed during the business hours of your client? Yes No

If "YES", please give full details:

Quote Required...

Please nominate the amount of cover you require:

$5,000,000

$10,000,000

$20,000,000

Underwriting questions...

Number of full time employees:
Number of part time employees:
Estimated Wage-roll for next 12 months:
Estimated turnover of the business per year:

Contractors...

Do you employ contractors or sub-contractors?

Yes No

If you answered "YES", what duties do they perform?
What is the estimated annual payments to these contractors?
Do they have their own Public Liability cover?	Yes No
Do they have their own Workers Compensation cover?	Yes No

Labour Hire...

Do you use labour from labour hire companies?

Yes No

If you answered "YES", what duties do they perform?
What is the estimated annual payments for labour hire?

Insured's History...

Have you (or any person receiving cover under this policy) ever:

Had insurance cancelled or declined by an Insurer?

Had a proposal rejected, renewal refused or claim rejected by an Insurer?

Had any special conditions imposed?

Suffered a loss whether insured or not (last 5 years only)?

Been involved in a company that has declared bankruptcy or insolvency?

Been liable for any civil offence or pecuniary penalty (exceeding $5,000)?

Been charged or convicted for actual or threatened damage to property?

Been charged or convicted for fraud, theft or dishonesty of any kind?

Been charged or convicted for drugs or any OTHER criminal offence?

Yes No

If you answered "YES" above, please give full details:

Declaration...

By submitting this Declaration, I/we declare and agree that:

I/we have the consent of all other persons covered by this policy to make this Declaration,
the contents of this Declaration are true and complete,
I/we have read the information concerning the duty of disclosure (immediately below this declaration) and other important notices;
I/we have answered every question fully and frankly, have been truthful and accurate in completing this application and have not withheld any information likely to affect the acceptance of this insurance;
I/we realise that if I/we have not complied with the duty of disclosure, any claims may not be met
if anything happens during the Period of Cover which alters any of the information provided, I/we will promptly inform the insurer;
they authorise the insurer to give or obtain from other insurers or insurance reference bureaus or credit reporting agencies, any information about this insurance or any other insurance held by the Applicant/s.

Name of person making this declaration:

Duty of Disclosure – What you must tell us
Under the Insurance Contracts Act 1984 (the Act), you have a Duty of Disclosure. You are required before you enter into, renew, vary, extend or reinstate your Policy, to tell us everything you know and that a reasonable person in the circumstances could be expected to know, is a matter that is relevant to our decision whether to insure you, and anyone else to be insured under the Policy, and if so, on what terms.

You do not have to tell us about any matter
that diminishes the risk
that is of common knowledge
that we know or should know in the ordinary course of our business as an insurer, or
which we indicate we do not want to know.
If you do not tell us

If you do not comply with your Duty of Disclosure we may reduce or refuse to pay a claim or cancel your Policy. If your non-disclosure is fraudulent we may treat this Policy as never having worked.