PI Insurance - Energy Assessors

Please fill out the following form. Once completed, click the Submit button and a formal quote will be presented promptly.

This proposal is for Energy Assessors / Energy Raters only. If your business includes activities other than these, you need to complete one of our other forms which can cater for your multiple activities.

Click here for access to other forms: Other Occupations

If you need advice, please call 1300 881 779

 
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:

Client Details

Insured Name

Trading Name

ABN No.(if known)

Full Address

Email Address

Phone No. *

Professional Duties

Please provide a breakdown of Your business activities.

Income by Type of Service

%  Energy Assessing / Energy Rating

%  Carbon Accounting

%  Other Assessing:

If Other, please provide details:

Area of Industry

Please provide a breakdown of the areas of Your business activities.

Income by Area of Service

%  Residential dwellings

%  Schools, hospitals, municipal buildings & recreational centres

%  Small commercial properties valued at $1,000,000 or less

%  Medium commercial properties valued from $1,000,000 to $5,000,000

%  Large commercial properties valued in excess of $5,000,000

%  Other

If Other, please give details

Note: If your total fee income is from Residential Dwellings only ie. Residential dwellings 100%, we will rate you as Energy Assessors - Residential Only. (This will entitle you to a lower premium).

Do you agree to be rated as Energy Assessors - Residential Only?
Yes    No

 

Underwriting questions

No. of directors /partners:  

No. of qualified assessors:  

What is your annual business turnover?

Please state the percentage of Your activities (based on income) for each State

ACT NSW NT QLD
 %      %      %      %    

SA TAS VIC WA O/Seas
 %      %      %      %      %    

 

Manual Risk Exposure

If you are after Public Liability cover as well, we need this question to be answered, otherwise proceed to the next question.

Does your business involve any of the following?

  • Manual labour or manual tasks performed by yourself (apart from measuring)
  • The supervision of manual labour or manual tasks performed by other parties or
  • The responsibility of manual labour or manual tasks performed by other parties.
  • The training of others on how to perform manual tasks
Yes    No

If you answered Yes, what duties do they perform?

 

Contractors

Do you employ contractors, sub-contractors?
Yes    No

If you answered Yes, what duties do they perform?

Do You require cover for sub-contractors?
Yes    No

If "NO", do You insist they carry their own insurance?
Yes    No

 

Quote Required

Please nominate the amount of covers you require:

Professional Indemnity

$1,000,000

$2,000,000

$5,000,000

$10,000,000

Public Liability

Not required

$5,000,000

$10,000,000

$20,000,000

 

Insured's History

Have you been previous insured for Professional Indemnity?
Yes    No

If you answered "Yes", please provide the following details:

Insurers Name

Limit of Indemnity
$

Expiry date

Have any claims ever been made against You, your predecessors in business or of the present or past Partners or directors?
Yes    No

Are you aware, after enquiry, of any CIRCUMSTANCES which may result in any claims against you, your predecessors in business or any of the present or former Partners/Principals?
Yes    No


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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:


 

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.

Claims Made Policy
The Professional Indemnity section of this Policy operates on a 'Claims made and notified' basis. This means that the Policy covers you for Claims made against you and notified to us during the Period of Insurance.
This Policy does not provide cover in relation to:
  • acts, errors or omissions actually or allegedly committed prior to the retroactive date of the Policy (if a date is specified);
  • claims made after the expiry of the period of insurance even though the event giving rise to the Claim may have occurred during the period of insurance;
  • claims notified or arising out of facts or circumstances notified (or which ought reasonably to have been notified) under any previous Policy;
  • claims made, threatened or intimated against you prior to the commencement of the period of insurance;
  • facts or circumstances of which you first became aware prior to the period of insurance, and which you knew or ought reasonably to have known had the potential to give rise to a Claim under this Policy;
  • Claims arising out of circumstances noted on the proposal form for the current period of insurance or on any previous proposal form.
Where you give notice in writing to the insurer or any facts that might give rise to a claim against you as soon as reasonably practicable after you become aware of those facts but before the expire of the period of cover, you may have rights under Section 40(3) of the Insurance Contracts Act 1984 to be indemnified in respect of any claim subsequently made against you arising from those facts notwithstanding that the claim is made after the expiry of the period of cover. Any such rights arise under the legislation only. The terms of the Policy and the effect of the Policy is that you are not covered for claims made against you after the expiry of the period of cover.