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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.


Insured Name:

Trading Name:

ABN No.(if applicable):

Postal Address:

Email Address:

Telephone No:

 

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:     

 

Insurance 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

Existing Structures...

Are there any alterations to Existing Structures? Yes    No
If "YES", please give details:

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
Describe what is involved:

 

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)

If Yes to any of the above questions, please describe.

 

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:    

 

Declaration...

By submitting this Declaration, I/we declare and agree that:
  • I/we have the consent of all other persons covered by this policy to make this Declaration,
  • the contents of this Declaration are true and complete,
  • I/we have read the information concerning the duty of disclosure (immediately below this declaration) and other important notices;
  • I/we 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/we realise that if I/we 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/we will promptly inform the insurer;
  • 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 tell us
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.