Step 1.
Select Level of Cover $5,000,000 $10,000,000 $20,000,000
Step 2.
Step 3. (Optional)
Include Professional Indemnity $1,000,000 +($500) or Include Professional Indemnity $2,000,000 +($800)
Cardholders Name
Credit Card No.
Select Expiration Date: 01 02 03 04 05 06 07 08 09 10 11 12 23 24 25 26 27 28 29 30
Please complete the form below together with a start Date.
When do you want cover to start?
Processing is only done through business hours. Cover is not in place until this form is received and accepted by our office. We will then email you a tax invoice. NOTE: A "Certificate of Currency" will not be sent until payment is made.
This policy does not provide Professional Indemnity cover ie. it does not provide indemnity against any breach of professional duty eg. losing the photos. Do you want us to send you a form for Professional Indemnity? Yes No
Name of person making this declaration: