IT Insurance

To receive a confirmed quote, please complete the form below.

If you would prefer to talk to a broker first, please call 1300-881-779
during business hours and receive an indicative quote over the phone.

Client Details

If you have spoken to a broker in our office, note their name here so that this quote can be processed by them as they will know something about you already.

Brokers Name:

Insured Name

Trading Name

ABN No.(if known)

Full Address

Email Address

Website Address

Phone No. *

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

Does Your business incorporate any prior trading entities?
Yes No

Professional Duties

What is your occupation (eg.Software Designer):

Please provide Us with a full description of Your business activities. This should include a description of the primary purpose of software/systems provided, sold or licensed including details of any advice provided

Qualifications

Do you hold the necessary qualifications required to perform all the professional services you have selected to be included in your cover?
Yes No

Quote Required

Please nominate the amount of covers you require:

Professional Indemnity

$1,000,000

$2,000,000

$5,000,000

$10,000,000

Public Liability

Not required

$5,000,000

$10,000,000

$20,000,000

IT Services Provided

Please provide a percentage breakdown of Your business activities:

Revenue by Type of Service

Application software development contract programming		%
Billing Services		%
Bureau services		%
Data communication services (ISP)		%
Data processing/warehousing services		%
Education and Training Services		%
Hardware sales (Reseller)		%
Hardware sales (Own developed or exclusive importer)		%
Help Desk services		%
Integration services		%
Internet Service Provider		%
IT General Consultancy		%
IT Project Management		%
Maintenance services		%
Network services		%
Pre-packaged 3rd Party software sales (Reseller)		%
Pre-packaged software sales (Own developed or exclusive importer)		%
Telecommunication services		%
Other		%

Please provide details:

Underwriting questions

No. of people in the business

Gross Fees last 12 months - If Nil, put "0"

Australia
USA/Canada
Elsewhere

Estimated Fees for next 12 months - If Nil, put "0"

Australia
USA/Canada
Elsewhere

Do you require USA and Canada Coverage?
Yes No

Is more than 25% of the Your fees/income derived from the Finance & Banking sector?
Yes No

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

ACT	NSW	NT	QLD
%	%	%	%

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

Has any contract or project experienced cost overruns, delays in implementation, failure or system(s) or product(s) to meet full functionality?
Yes No

Have any clients refused payment or requested a refund of money?
Yes No

Do You provide any services or supply components in the following industries?

Adult Entertainment
Yes No

Agricultural applications
Yes No

Artificial intelligence application or system
Yes No

Aviation, radar, aircraft, watercraft
Yes No

Critical parts of autos or other transportation equipment/controls
Yes No

Encryption software (Designer or Manufacturer)
Yes No

Financial Transaction or Analysis Software
Yes No

Fire, security or other emergency processes/applications (eg.CCTV)
Yes No

Industrial control systems/SCADA/robotics
Yes No

Manufacturing systems (eg. control systems, robotics, PLC, CAM)
Yes No

Medical technology (excluding admin and management systems)
Yes No

Military technology (weapons and combat systems)
Yes No

Mining industry applications
Yes No

Online Gaming or gambling applications
Yes No

Pollution control device systems
Yes No

Privacy applications
Yes No

Public Key Infrastructure software (design or manufacture)
Yes No

Resource processes (oil, gas, power, nuclear, waste disposal etc.)
Yes No

Security systems
Yes No

Services to stock exchange,broking or clearing house systems
Yes No

Telecommunications carriers
Yes No

Transport industry
Yes No

Utilities - water & power generation/distribution software
Yes No

Do You undertake any welding or hot work?
Yes No

Do You undertake any underground digging or trenching?
Yes No

Contractors

Do you employ contractors, sub-contractors?
Yes No

Do You require cover for sub-contractors you hire?
Yes No

Contracts

Do You always enter into written contracts with your clients covering the
specifications of products or services that You have agreed to provide?
(Time and Materials based contracts are acceptable for a "YES" answer).
Yes No

Have you entered into any contracts or agreements which contain:

An "Hold Harmless" clause, "Indemnity Clause" or "Joint Insured" clause?
Yes No

"Hold Harmless" means you can't sue the other party even if they are at fault
"Indemnity" is where you agree to reimburse the other party for their losses whether you are at fault or not.
"Joint Insured" means that you have agreed to add the other party onto your policy as co-insured

NOTE: All contracts should be checked by your lawyer before signing.

Insured's History

Have any Professional Indemnity or Liability claims been made against this Business or any of its predecessors or any prior business of any of its former Partners, Principals or Directors, or have circumstances been notified to insurers that might give rise to a claim?
Yes No

Is any applicant aware of any claim or circumstances that might give rise to a claim against the Business or any prior business of any of their present or former Partners, Principals or Directors, which matter is not referred to above?
Yes No

Has any applicant ever been subject to disciplinary proceedings for professional misconduct?
Yes No

Has any applicant ever had a Liability Insurer decline to continue the applicant's insurance or cancel their insurance?
Yes No

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

Been involved in a company that has 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

CAPTCHA Code: 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:

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.