Professional Indemnity for Bookkeepers & BAS Agents

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

Step 1.

 

Step 2. (Optional)


or

Option 1. Proceed with Cover...

Visa    MasterCard

Cardholders Name

Credit Card No.

Select Expiration Date:
   

Option 2: Proceed with Cover but pay on Invoice

Please complete the form below together with a start Date.

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.

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.

 

Client Details

Insured Name

Trading Name

ABN No.(if known)

Full Address

Email Address

Website Address

Phone No. *

 

Professional Duties

Percentage (must add up to 100%)

BAS Agents

  %

Bookkeeping Services

 %

Tax Agents  %

 

Do you provide any services to Publicly Listed Companies or Financial Institutions?
Yes    No

 

Underwriting questions

No. of people in the business  

 

Gross Revenue - last year   If Nil, put in "0"

  Australia

  Elsewhere

Estimated for next year   If Nil, put in "0"

  Australia

  Elsewhere

 

Insured's History

Has any Claim been made, or has any civil liability been alleged in the last ten (10) years against the business or any of their predecessors in business or any prior practice of any of their present or former Partners, Principals or Directors, or have circumstances been notified to insurers that might give rise to a claim
Yes    No

Is anyone in the business aware of any CIRCUMSTANCES which may give rise to a claim against this business?
Yes    No

Have you (or any person receiving cover under this policy) ever:

  • been refused this type of insurance or had similar insurance cancelled, or had an application of renewal declined, or had special terms imposed?
  • been subject to disciplinary proceedings for professional misconduct?
  • been declared bankrupt?
  • been the subject of administration proceedings?
  • been the subject of administration proceedings?
Yes    No

 

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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,

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
  • that diminishes the risk
  • that is of common knowledge
  • that we know or should know in the ordinary course of our business as an insurer, or
  • which we indicate we do not want to know.
  • If you do not tell us

If you do not comply with your Duty of Disclosure we may reduce or refuse to pay a claim or cancel your Policy. If your non-disclosure is fraudulent we may treat this Policy as never having worked.

Claims Made Policy
This declaration is for a claims made and notified Policy of insurance. This means that the Policy covers you for claims made against you and notified to the insurer during the period of cover. This Policy does not provide cover in relation to:

  • claims made after the expiry of the period of cover even though the event giving rise to the claim may have occurred during the period of cover;
  • claims notified or arising out of facts or circumstances notified (or which ought reasonably to have been notified) under any previous Policy;
  • claims made, threatened or intimated against you prior to the commencement of the period of cover;
  • facts or circumstances of which you first became aware prior to the period of cover, and which you knew or ought reasonably to have known had the potential to give rise to a claim under this Policy;
  • claims arising out of circumstances noted on the Proposal form for the current period of cover or on any previous Proposal form.
Where you give notice in writing to the insurer or any facts that might give rise to a claim against you as soon as reasonably practicable after you become aware of those facts but before the expire of the period of cover, you may have rights under Section 40(3) of the Insurance Contracts Act 1984 to be indemnified in respect of any claim subsequently made against you arising from those facts notwithstanding that the claim is made after the expiry of the period of cover. Any such rights arise under the legislation only. The terms of the Policy and the effect of the Policy is that you are not covered for claims made against you after the expiry of the period of cover.