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Office Insurance...

To get a quote - just fill in the form below and submit.
Please make sure you answer all the questions especially your contact details.

If you have 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:

Insured Name:

Trading Name:

ABN No.(if known):

Postal Address:

Email Address:

Website Address:

Telephone No:

 

Details of the business...

Type of Business (eg. tax agent)

Full address of premises

Start date of business

 

Construction of the business premises...

Construction of Walls

Construction of Floors

Construction of Roof

Is (EPS) Sandwich Foam Panel construction used?
Yes    No

Year Built? (approx)

 

How are premises protected?...

Sprinkler system Yes    No
Automatic fire alarm Yes    No
Fire hoses Yes    No
Extinguishers Yes    No
Deadlocks on doors Yes    No
Bars and/or keylocks on all external windows Yes    No
Burglar alarm system Yes    No
If you have an alarm, which type?

 

Fire & Perils Insurance...
Is this cover required?    Yes    No

If Yes, please fill in the sums insured required below:

Building sum insured (includes removal of debris)

Stock in trade

All other contents

Business Interruption...

Need more information about this cover -  Click here

Is this cover required?    Yes    No

If Yes, please fill in the sums insured required below:

Annual business turnover

Burglary...

Is this cover required?    Yes    No

If Yes, please fill in the sums insured required below:

Stock in Trade

All other Contents (excluding stock)

Money...

Is this cover required?    Yes    No

If Yes, please fill in the sums insured required below:

Glass...

Is this cover required?    Yes    No

If Yes, the glass will be insured for it's replacement value.

Public Liability...

Is this cover required?    Yes    No

If Yes, please select a sum insured:

What is your annual business turnover?

$

Do you import / export goods?
Yes    No

Do you perform work away from your premises?
Yes    No

Your History...

Have you or anyone to be insured under this policy:

Sustained any loss, damage, injury or liability in the last five years, whether insured or not?
Yes     No    

Had insurance declined, renewal refused, terminated or special conditions imposed by any insurer?
Yes     No    

Ever been declared bankrupt or gone into liquidation?
Yes     No    

Ever received any threats to life or property
Yes     No    

Had a criminal conviction or conviction pending?
Yes     No    

   

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:


 

 

   

   

If you need any help or advice, please call    1300 881 779