Professional Indemnity Insurance - Railway Services

To receive a confirmed quote, please complete the form below. Depending on the details of your profession, we will endeavour to provide you with 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 1300-881-779 between 8.15am and 5.15pm E.S.T. business days and receive an indicative quote over the phone.

Insured Name:

Trading Name:

ABN No.(if applicable): 

Full Address:

Email Address:

Website Address (if applicable):

Telephone No:

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:

 

Do you require cover for any subsidiary, joint venture or associated company?
Yes    No

Professional Duties...

What is your occupation (eg. railway consultant):

The Insurer is insuring your professional ability to do your job. They need to understand exactly what you do. Detail in easy to understand English what your job entails and to what industries you perform your work.

 

Qualifications...

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

 

Previous Insurance...

Have you been previous insured for Professional Indemnity?
Yes    No

If you answered "Yes", please provide the following details:
Insurers Name
Limit of Indemnity ($)
Expiry date

 

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...

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

Does your business involve any of the following?

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

Yes    No

If you answered "Yes", what duties do they perform?

   

Underwriting questions...

No. of people in the business
.
Gross Fees last 12 months Australia

USA/Canada

Elsewhere
.
Estimated Fees next 12 months Australia

USA/Canada

Elsewhere

 

State the percentage of Your activities (based on income) applicable to each State
ACT NSW NT QLD
 %      %      %      %    

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

 

Contractors...

Do you employ contractors or 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 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 been subject to disciplinary proceedings or actions for misconduct in a professional respect?
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 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 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.