Professional Indemnity for Environmental Consultants

To receive a confirmed quote, please complete the form below. You will receive a confirmed quote on the same business day or the next business day if received after hours.

If you prefer to talk to a broker first, please call 1300-881-779 between 8.15am and 5.15pm E.S.T. business days.

Client Details

Full Name of Insured:

Trading Name:

ABN No.(if applicable):

Full Address:

Email Address:

Website Address (if applicable):

Telephone No:

Start date of business:

If you have 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:

Do You require cover for any subsidiary or associated company?
Yes No

Does Your business incorporate any prior trading entities?
Yes No

Occupation

Please provide us with a full description of Your business activities.

Qualifications

Do you hold the necessary qualifications to perform all the required tasks of your profession?
Yes No

Previous Insurance

Have you been previous insured for Professional Indemnity ?
Yes No

If "Yes", please provide the following details:

Insurers Name

Limit of Indemnity ($)

Expiry date

Area of Work

Do you mainly consult to private industry or public government institutions?

Private industry		%
Government institutions

Please provide a percentage breakdown of the area of work performed:

Income by area of work - (must add up to 100%)
POLLUTION MANAGEMENT ACTIVITIES
Air pollution control	%
Waste water management	%
Solid waste management	%
Remediation and clean up of soil & water	%
Noise & vibration abatement	%
Environmental monitoring, analysis & assessments	%
Pollution Management Activities - Other	%
If "Other", we will need to ask you for full details.

CLEANER TECHNOLOGIES
Cleaner resource efficient technologies & processes	%
Cleaner resource efficient products	%
Cleaner technologies - Other	%
If "Other", we will need to ask you for full details.

RESOURCE MANAGEMENT
Indoor air pollution control	%
Water supply	%
Recycled materials & manufacturing	%
Renewable energy	%
Energy saving & management	%
Sustainable agriculture & fisheries	%
Sustainable forestry	%
Natural risk management	%
Eco-tourism	%
Nature conservation, habitat & biodiversity etc.	%
Resource Management - Other:	%
If "Other", we will need to ask you for full details.

Quote Required

Please nominate the amount of covers you require:

Professional Indemnity .	Public Liability
$1,000,000	Not required
$2,000,000	$5,000,000
$5,000,000	$10,000,000
$10,000,000	$20,000,000

Underwriting Questions

Number of directors / partners
No. of qualified staff (other than directors)
Gross Fees last 12 months - If Nil, put in 0
Australia
USA/Canada
Elsewhere
Estimated Fees next 12 months - If Nil, put in 0
Australia
USA/Canada
Elsewhere

Please state the percentage of Your activities (based on income) applicable to each State

ACT	NSW	NT	QLD
%	%	%	%

SA	TAS	VIC	WA	O/Seas
%	%	%	%	%

Manual Risk Exposure

If you are after Public Liability cover as well, we need this question to be answered, otherwise proceed to the next question.

Does your business involve any of the following?

Manual labour or manual tasks performed by yourself (apart from measuring)
The supervision of manual labour or manual tasks performed by other parties or
The responsibility of manual labour or manual tasks performed by other parties.
The training of others on how to perform manual tasks

Yes No

Contractors

Do you employ contractors, sub-contractors?
Yes No

Do You require cover for sub-contractors?
Yes No

If "NO", do You insist they carry their own insurance?
Yes No

Insured's History

Have You ever been subject to disciplinary proceedings or actions for misconduct in a professional respect?
Yes No

Have You ever been subject to any claims for civil liability or breach of professional duty in the last ten years?
Yes No

Have You notified circumstances to insurers that may give rise to such a claim?
Yes No

Are You aware of any other facts or circumstances which may give rise to a professional indemnity insurance claim?
Yes No

CAPTCHA Code: Type the above number:

Declaration

By submitting this Declaration, I/we declare and agree that:

I/we have the consent of all other persons covered by this policy to make this Declaration,
the contents of this Declaration are true and complete,
I/we have read the information concerning the duty of disclosure (immediately below this declaration) and other important notices;
I/we have answered every question fully and frankly, have been truthful and accurate in completing this application and have not withheld any information likely to affect the acceptance of this insurance;
I/we realise that if I/we have not complied with the duty of disclosure, any claims may not be met
if anything happens during the Period of Cover which alters any of the information provided, I/we will promptly inform the insurer;
I/we confirm that I/we have read and understood that this policy operates on a claims made and notified' basis; (refer - Claims Made Policy below)
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:

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
The Professional Indemnity section of this Policy operates on a 'Claims made and notified' basis. This means that the Policy covers you for Claims made against you and notified to us during the Period of Insurance.
This Policy does not provide cover in relation to:

acts, errors or omissions actually or allegedly committed prior to the retroactive date of the Policy (if a date is specified);
claims made after the expiry of the period of insurance even though the event giving rise to the Claim may have occurred during the period of insurance;
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 insurance;
facts or circumstances of which you first became aware prior to the period of insurance, 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 insurance 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.