Public Liability Insurance - Tradesmen

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

Number of tradesmen (on tools) **
including principals






6 or more - Call our office or fill the form below

Option 1: Proceed with Cover - Pay Now

Visa    MasterCard

Cardholders Name

Credit Card No.

Select Expiration Date:
   

Option 2: Proceed with Cover but pay on Invoice

Cover will be placed and a Tax Invoice will be emailed to you.

Note: A Certicate of Currency cannot be issued until payment is made.

Please complete the form below...

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.

 

Insured Name

ABN No. (if known)

Full Address

Email Address

Phone No.

Start date of business (year):

Trade Duties

What is your occupation (eg.bricklayer):

Please provide full description of Your business activities.

Cover Required

Please nominate the amount of cover you require:
Limit of indemnity:
$5,000,000
$10,000,000
$20,000,000

Underwriting Questions

Number of full time employees:

Number of part time employees:

Estimated turnover per year:

Does the business:

Undertake work on large industrial sites?
Yes    No

Undertake welding or hot cutting activities away from own premises?
Yes    No

Perform work at mine sites, either above or below ground?
Yes    No

Provide products or services intended for use in the mining industry?
Yes    No

Provide equipment on hire?
Yes    No

Import any products into Australia?

Yes    No

Export any products to the USA or Canada?

Yes    No

Is the business involved in any of the following activites?
- Wharf or any form of ship handling or loading facility
- Aircraft, Airports, Airlines, Satellites, Space or Radar Installations
- Public Utilities (eg Power Plants, Water Treatment, Communication)
- Military Installations
- Dams
- High voltage power supply
- Railways
- Chemical Manufacturers
- Oil and/or Gas Production
Yes    No

Contractors

Do you employ contractors or sub-contractors?
Yes    No

Labour Hire

Do you engage personnel provided through labour hire companies?
Yes    No

Your History

Have you or anyone to be insured under this policy:

  • Had insurance cancelled or declined by an Insurer?
  • Had a 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 declared bankrupt or insolvent?
  • Been liable for any civil offence or pecuniary penalty?
  • Been charged or convicted for any criminal offence?
  • Been charged or convicted for fraud, theft or dishonesty?
Yes     No


Type the above number:



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 the insurer 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 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: