Contract Works Insurance - Single Projects

We need you to complete this quick form so that we can get the best quote for you.

If you would prefer to talk to a broker first, please call 1300-881-779 between 8.15am and 5.15pm EST. business days.

 

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

Postal Address

Email Address

Phone No.

Contract Details


Proposer's Interest:
Principal
Contractor
Owner builder

Has the project already commenced?
Yes    No

Start Date of Project

Projected Finishing Date

Address of Project:

Details of Project (eg.house, shop):

Maximum number of storeys *

Maximum number of basement levels *

Contract Details

Are there any alterations to Existing Structures?
Yes    No

Will Existing Structures be occupied during Project?
Yes    No

Do you require insurance cover for those Existing Structures?
Yes    No

Demolition Work

Is demolition value greater than 25% of the project?
Yes    No

Will the Project Involve any of the following

Is there any demolition involved?
Yes    No

Construction of straw bale homes
Yes    No

Blasting or explosives (other than nail guns)
Yes    No

Buildings or structures of historical significance
Yes    No

Underground works,tunnels,shafts,mines or galleries
Yes    No

Any work in,on,over or under a permanent body of water
Yes    No

Directional drilling or boring greater than 50cm in diameter (not pilings/piers)
Yes    No

Swimming pools
Yes    No

Schools, hospitals, universities,shopping centres, hotels or railway stations
Yes    No

Technology which is of a prototype nature
Yes    No

Will there be any retaining walls greater than 15m in length or 1.5m in height
Yes    No

Will any work be done in flood prone or high annual rainfall zones
Yes    No

Maximum excavation depth (metres)

 

Sum Insured (Material Damage)

Contract price (full value of project)
$

Principal Supplied Materials
$

Existing Structures to be insured
$

Contractors Plant, Tools & Reusable Equipment (extra premium payable)

Hand Tools
$

Scaffolding / Formwork/ Sheds
$

Plant (Contractors)
$

 

Sum Insured (Public Liability)

Please nominate the amount of cover you require:


Type the above number:



Declaration

By submitting this Declaration, the Applicant acknowledges:
- they are authorised by all the Applicants to make this Declaration,
- the contents of this form 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 form up until the contract is entered into,

Name of person making this declaration: