Professional Indemnity Proposal

You have been directed to this page because we need to find out more information about what you do before we can quote.

If you prefer to talk to a broker first, Free Call 1300 881 779 between 8.15am and 5.15pm E.S.T. business days and receive an indicative quote over the phone.

 
Insured Name:
Address:
Town/Suburb:
Postcode:

Email Address:
Telephone No:
Start date of business:

 

Do you require cover for any subsidiary, joint venture or associated company?

Yes    No

 
Professional Duties...
What is your occupation (eg.management consultant):

Are you involved in corporate consulting to large Public Companies?

Yes    No

 

Qualifications...
Do you hold the necessary qualifications to perform all the required tasks of your profession?

Yes    No

 

Previous Insurance...
Have you had previous Professional Indemnity insurance?

Yes    No

 

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

 

Manual Risk Exposure...
Does your business involve any of the following?
  • Manual labour or manual tasks performed by yourself
  • The supervision of manual labour or manual tasks performed by others
  • The responsibility of manual tasks performed by other parties.
  • The training of others on how to perform manual tasks
Yes    No

 

Underwriting questions...
No. of people working in the business

Gross Fees last year
Australia
USA/Canada
Elsewhere

Estimated Fees next next

Australia
USA/Canada
Elsewhere

 

Contractors...
Do you employ contractors or sub-contractors?

Yes    No

 

Insured's History...
Have any claims been made against You or Your business or any prior
business or has any fact or circumstance been notified to insurers that
has the potential to give rise to such 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:

  • Had insurance cancelled or declined by an Insurer?
  • Had a 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 involved in a company that has been declared bankrupt or insolvent?
  • Been charged or convicted for any criminal offence?

Yes    No


Type the above number:



Declaration...
By submitting this Declaration, the Applicant acknowledges:
  • I have the consent of all other persons covered by this policy to make this Declaration,
  • I have read the information concerning the duty of disclosure (immediately below this declaration) and other important notices;
  • I 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 realise that if I 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 will promptly inform the insurer;
  • I confirm that I have read and understood that this policy operates on a claims made and notified' basis; (refer - Claims Made Policy below)

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 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.