Professional Indemnity Insurance by Liability Brokers

Home Sustainability Assessors - Quotation Request...

A Service Company

Please fill out the following form. Once completed, click the Submit button and a formal quote will be presented promptly.

This policy is underwritten by QBE Insurance (Australia's leading insurer) and has been approved by ABSA.

This proposal is for Home Sustainability Assessors & Energy Raters only. If your business includes activities other than these, you need to complete one of our other forms which can cater for your multiple activities. Click here for access to other forms: Other Occupations

The Insurer will not cover you in respect of any property valuations.

NOTE: Make sure you put in your correct email address as a copy of this submission will be emailed to that address.

If you need advice, please call Liability Brokers: 1300 881 779

Insured Name:

Trading Name:

ABN:

"TBA" if not known

Street Address:

Suburb/Town

Postcode

Tel No:

Mobile:

Email Address:

Professional Duties...

Insured Occupation

Does your business involve manual risk exposure? Yes No

ie. does your occupation involve:
1. Manual labour peformed by yourself (apart from measuring)
2. The supervision of manual labour performed by other parties or
3. The responsibility of manual labour performed by other parties.

If "YES", please give details:

Insured's History...

Have any claims ever been made against You, your predecessors in
business or of the present or past Partners or directors? Yes No

If "YES", please give details:

Are you aware, after enquiry, of any CIRCUMSTANCES which may
result in any claims against you, your predecessors in business
or any of the present or former Partners/Principals? Yes No

If "YES", please give details:

Sum Insured ...

Professional Indemnity

Public Liability cover for $10,000,000 is automatically included

Declaration...
By submitting this Declaration, the Applicant acknowledges:

they are authorised by each of the other Applicants to make this Declaration,
the contents of the Declaration are true and complete,
they are under a continuing obligation to immediately inform QBE of any change in the particulars or statements contained in this Declaration or in the accompanying documents up until the contract is entered into,
they authorise QBE Insurance (Australia) Limited 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:
Dated: