Public Liability Insurance

Public Liability 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:

Annual Turnover:

Occupation:

Occupation - Please give full details of your business operations:

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 Public Liability insurance? Yes No

Do you hire personnel through labour hire companies? Yes No

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