Public Liability Insurance for Mine Surveyors

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 would prefer to talk to a broker first, please call Liability Brokers between 8.15am and 5.15pm E.S.T. business days and receive an indicative quote over the phone.

 

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:

Client Details

Insured Name

Trading Name

ABN No.(if known)

Full Address

Email Address

Website Address

Phone No. *

Occupation: Mine Surveyor

When did the business start (year)?

Do you perform other activities apart from mine surveying that require insurance?
Yes    No

If "YES", please give details:

Do Your Business activities include the management of any building or erection projects or the manufacturing of any products?
Yes    No

If "YES", please give details:

Manual Risk Exposure

This policy is not available for occupations that involve a manual risk exposure ie. if you are involved in performing manual labour or the supervision of manual tasks. This would include showing others how to perform manual works eg. how to lift goods.

Does your occupation involve manual risk exposure?
Yes    No

ie. does your occupation involve:

  • Manual labour or manual tasks performed by yourself
  • The supervision of manual labour or manual tasks performed by others
  • The responsibility of manual labour or manual tasks performed by others
  • The training of others on how to perform manual tasks

 

Cover Required

Please nominate the amount of cover you require:

$5,000,000

$10,000,000

$20,000,000

 

Underwriting Questions

No. of full time employees:  

No. of part time employees:

What is your annual business turnover?
$

 

Contractors

Do you employ contractors or sub-contractors?
Yes    No

Your History

Have you or anyone to be insured under this policy:

  • 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:



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: