We need to find out what you do before we can quote.
You have two options:
If you have spoken to a broker in our office, note their name here so that this quote can be processed by them as they will know something about you already.
Brokers Name:
Insured Name
Trading Name
ABN No.(if known)
Full Address
Email Address
Website Address
Phone No. *
When did the business start (year)?
Please give a full description of your occupation. By giving a full description the insurer gets an understanding of what you do and can then favourably rate your premium.
Please nominate the amount of cover you require:
Public Liability
Not required
$5,000,000
$10,000,000
$20,000,000
Number of employees (include principals)
Number of labour hire, contract labourers:
Estimated turnover of the business per year $
What percentage of turnover is heat work away from your premises? % (ie welding or hot cutting activities)
Do you employ contractors or sub-contractors? Yes No
If YES,
What percentage of turnover is generated from sub-contractors? %
Do they have their own Public Liability cover? Yes No
Do you require cover for sub-contractors? Yes No
The questions below relate to the insured, or any partner or director or any other person responsible for managing the business. They also relate to any other business in which the insured or partners/directors have been trading. Have any of the above:-
By submitting this Declaration, the Applicant declares that:
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: