1300 583 933
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Please select insurance type
Business Insurance / Public Liability
Professional Indemnity
Car/Motor/Truck Insurance
Home & Contents
Other
Business Insurance / Public Liability
Details:
Please enter entity name
Please enter contact person
Please enter email
Please enter phone
Please enter address
Please enter business activity
Please enter estimated turnover
Please select
No. of Employees
1
2
3
4
5
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46
47
48
49
50
Please enter amount
Please select public liability limit
Please select
$10 million
$20 million
Any Tools/ General property cover required?
No
Yes
Please enter comments
Any bankruptcy or claims made in last 5 years?
No
Yes
Please enter comments
Any importing?
No
Yes
Please fill all the fields
Situation cover requried?
No
Yes
Please fill all the fields
Construction Details
Amount of cover required
Please fill the fields
Burglary limit
No
Yes
Please enter amount
Glass Cover
No
Yes
Please enter amount
Machinery breakdown
No
Yes
Please enter amount
Business Interruption
No
Yes
Please enter amount
Professional Indemnity
Details:
Please enter entity name
Please enter contact name
Please enter email
Please enter phone
Please enter address
Please enter business activity
Please enter turnover
Please select employees
No. of Employees
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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31
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38
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40
41
42
43
44
45
46
47
48
49
50
Please enter amount
Please enter sub contractors
Please select cover
Cover Required:
$1 million
$2 million
$5 million
$10 million
$20 million
Please select
Any claims made in last 5 years:
Yes
No
Please enter details
Please select
Any bankruptcy or criminal records:
Yes
No
Please enter details
Please enter limit
Car/Motor/Truck Insurance
Details:
Please enter entity name
Please enter contact person
Please enter email
Please enter phone
Please enter garage address
Insurance History
Please select
Have you or any listed driver had any claims made in the past 5 years?
Yes
No
Please enter details
Please select
Have any drivers had any convictions for driving under the influence of alcohol in the last five years?
Yes
No
Please enter details
Please select
Have any drivers had their license suspended or cancelled in the last five years?
Yes
No
Please enter details
Vehicle Details:
Please enter year
Please enter make
Please enter details
Please enter rego
Please enter value
Please select garaging type
Garaging Type:
Garage
Carport
Driveway
Other
Please enter details
Please select
Any interested party?
Yes
No
Please enter details
Type of Insurance
Please select
Insurance Type
Comprehensive
Third Party Only (TPO)
Thir Party, Fire & Theft
Please select
Motor Usage
Business Use
Private Use
Driver Details
Please enter surname
Please enter DOB
Do you have additional vehicle?
Yes
No
Home & Contents
Section 1: Insured Details
Please enter surname
Please enter first name
Please enter DOB
Please enter email
Please enter phone
Please select
Retired
No
Yes
Please enter postal address
Please enter risk address
Please select
Have you had any claims in the past 5 years?
Yes
No
Please enter details
Please select
Any Mortgage
Yes
No
Please enter mortgage details
Section 2: What type of policy
Please select
Accidental Damage
Defined Events
Please select
Is your property on more than 5 acres?
Yes
No
Please select
Do you require flood cover?
Yes
No
Please select
Excess
Please select
$100
$250
$500
$1000
Section 3: Sums Insured
Please enter value
Please enter value
Please enter value
Please enter value
Section 4: Construction and Security
Please enter year
Please select
Please select
Single storey
Double storey
Please select
Building Type
Home
Unit
Other
Please enter building type
Please select
Construction Type
Brick
Timber
Other
Please enter construction type
Please select
Construction of Roof
Tile
Iron
Other
Please enter roof construction
Please select
Occupied by:
Please select
Owner Occupied
Tenant
Shared
Holiday Home
Vacant
Weekly rent
Security:
Back-to-base alarm
Window bars/grills
Deadlocks on doors
Keyed Window locks
Fixed safe
Local alarm
Other
Details:
Please enter name
Please enter phone
Please enter email
Please enter entity name
Please enter address
Please enter business activities
Please enter turnover
Please enter cover type
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Business Insurance
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