Cleaning Contractors - Public Liability

Please fill out the following form. Once completed, click the Submit button and a formal quote will be presented promptly.

This form is for Cleaning Contractors only. If your business includes activities other than these, you need to complete one of our other forms which can cater for your multiple activities. Click here for access to other forms: Other Occupations

NOTE: Make sure you put in your correct email address as a copy of this submission will be emailed to that address.

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

Insured Name:

Trading Name:

ABN: (if known)

Street Address:



Telephone No:

Email Address:

Start date of business:


If you have already spoken to someone in our Office, please note their name here so that this form can be processed by them as they will know something about you already.

Brokers Name:


Occupation: Cleaning Contractor...

Have you been in this trade or type of business for over 3 years?

Yes    No

This policy is for Cleaning Contractors only. If you perform other duties that are not normally defined as Cleaning work, please give full details:

Please supply a split of your work activities as a percentage:



Building Cleaning Service


Carpet Cleaning


Chimney Cleaning


Curtain Cleaning


House Cleaning


Office Cleaning


Shop Cleaning (Internal)


Shopping Centres (common areas)   




Window Cleaning - under 10 metres


Window Cleaning - over 10 metres





Does the business perform cleaning activities during trading or business hours?

Yes    No


Quote Required...

Please nominate the amount of cover you require:





Underwriting questions...

How many employees does your business have?

Full Time  

Part Time  

Estimated turnover of the business per year:  



Do you employ contractors or sub-contractors?

Yes    No


"If you answered YES",

Estimated annual payments to these contractors? $ 

Do they have their own Public Liability cover?

Yes   No

Do they have their own Workers Compensation cover?

Yes   No


Labour Hire...

Do you use labour from labour hire companies?

Yes    No


Insured's History...

Have you (or any person receiving cover under this policy) ever:
  • Had insurance cancelled or declined by an Insurer?
  • Had a proposal rejected, 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 become insolvent?
  • Been charged or convicted for any criminal offence?
Yes    No

Type the above number:


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: