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 Full time
Number of employees Part time
Estimated turnover of the business per year $
Do you, or do you intend to use, store or handle hazardous substances? Yes No
Do you discharge waste or hazardous material into the atmosphere, sewer or elsewhere? Yes No
Do you carry out any of the following: Use of explosives, bridge construction/maintenance, demolition activities, construction or maintenance work involving chemical works, defence, mines, offshore platforms, aircraft or aviation risks, utilities, gas production, petrochemical plants, power stations, rail, ships or marine risks? Yes No
Is any work performed by or on behalf of the insured at or on any of the following:-
Do you, or do you intend to carry out underground/excavation work exceeding 3 metres in depth? Yes No
Is work carried out limited to domestic and light commercial only? Yes No
Does the business take on individual contracts that exceed $100,000? Yes No
Does any of your work involve fire sprinkler systems? Yes No
Do you perform "hot work" away from own premises that involves the use of cutting, welding, grinding or soldering equipment? Yes No
Do you import or export goods/products? Yes No
Do you hire out equipment and/or staff? Yes No
Do you employ contractors, sub-contractors? Yes No
If YES,
Do they have their own Public Liability cover? Yes No
Do they have their own Workers Compensation cover? Yes No
Do you use labour from labour hire companies? Yes No
Have you (or any person receiving cover under this policy) ever:
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: