Business Insurance - Renewal Form

Business Insurance Renewal Form...

Please fill out the following form. Once you have completed the form, click the Submit button to send your information. Your insurance renewal will be handled promptly.

NOTE: Make sure you put in your correct email address as a copy of this submission will be emailed to that address.

Client Code:

(refer email)

Insured Name:

Email Address:

No.of employees:

Occupation:

Occupation - Please give full details of your business operations:

Protecting your business property
This cover pays for repair or replacement of your property if its damaged by fire
or other covered loss.

Please nominate a sum insured for:

The Buildings $

Stock in trade $

All other Contents $

The sum insured should represent the full replacement value.

Protecting your business income
This cover reimburses your loss of income resulting from a covered loss to your property.

Annual Turnover

The sum insured should represent the total annual turnover of the business.

Protecting your business against liability claims
Public liability insurance protects you and your business against the financial risk of
being found liable to a third party for death or injury, loss or damage of property or
economic loss resulting from your negligence

Please nominate a sum insured for:

Limit of Indemnity

Does your business:

Do welding or hot cutting activities away from your own premises? Yes No

Perform work at mine sites, either above or below ground? Yes No

Provide products or services meant for use in the mining industry? Yes No

Provide equipment on hire? Yes No

Import any products into Australia? Yes No

Export any products to the USA or Canada? Yes No

Please give full details for any ticked activities above:

Are You involved in any of the following activites?

Shipping / Port Authorities Yes No

Aircraft / Airports / Airlines Yes No

Public Utilities (ie Power Plants, Water Treatment, Communication) Yes No

Dams Yes No

Railways Yes No

Chemical Manufacturers Yes No

Oil and/or Gas Production Yes No

Please give full details for any ticked activities above:

Do you employ contractors or sub-contractors? Yes No

If "YES", do you make sure they have their own Liability cover? Yes No

Do you engage personnel provided through labour hire companies? Yes No

Workcover / Workers Compensation
Workers Compensation insurance is compulsory for all employees. You need to be very careful about what the definition of an employee is and this can vary from state to state. You need to be especially careful when hiring sub-contractors as they can sometimes be deemed to be employees under the various state workcover acts.The best course of actions is to call your state workcover authority for a ruling.

If you have no cover in place, then you should arrange cover immediately.

Would you like us to send out a Workcover application form to you? Yes No

Notes:
If there are any further comments, please detail here: