We need to find out what you do before we can quote.
You have two options:
If you have spoken to a broker in our office, note their name here so that this quote can be processed by them as they will know something about you already.
Brokers Name:
Insured Name
ABN No. (if known)
Full Address
Email Address
Phone No.
Start date of business (year):
What is your occupation (eg.bricklayer):
Please provide full description of Your business activities.
Please supply a split of your work activities as a %
% Residential dwellings
% Small Commercial
% Large Commercial
% Other
Please nominate the amount of cover you require:
Limit of indemnity: $5,000,000 $10,000,000 $20,000,000
Number of full time employees:
Number of part time employees:
Estimated turnover per year:
Do You carry out building work exceeding 10 metres in height? Yes No
Do you do welding or hot cutting activities away from own premises? Yes No
Do you import or export goods/products? Yes No
Does the business: - Perform work at mine sites, either above or below ground? - Provide products or services intended for use in the mining industry? Yes No
Do you provide equipment out on hire? Yes No
Is you business involved in demolition activities?
Yes No
Do you provide services or products for use in the following areas?
Do you employ contractors or sub-contractors? Yes No
If you answered YES,
Estimated annual payments to these contractors? $
Do they have their own Public Liability cover? Yes No
Do they have their own Workers Compensation cover? Yes No
Do you engage personnel provided through labour hire companies? Yes No
WARNING: Signing of Contracts There are potential insurance ramifications of signing contracts without appropriate legal advice. Many contracts have clauses that put the insured in a situation where they may not be covered under their liability policies. Policies usually have an exclusion relating to Contractual Liability. Basically, the exclusion states that the Insurer will only provide indemnity for any contractual liability where the signing of the contract does not increase the insured's liability beyond what would have applied had the contract not been signed.
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. If you have no cover in place, then you should arrange cover immediately. NOTE: We do not handle Workcover insurance but we can point you in the right direction if you need to arrange cover. Sub-Contractors - If you are not operating under a company structure and you hire sub-contractors that are not working under a company structure, then it is likely that you will be held responsible for any injuries that a sub-contractor incurs whilst performing work for your business. The fact that they may have their own ABN and submit invoices for their work is unlikely to get you off payment of their injuries
Have you or anyone to be insured under this policy:
By submitting this Declaration, the Applicant acknowledges:
Name of person making this declaration: