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Your Occupation or Business Type

If you can't find your occupation/business select 'Other'.

About Your Business

Company, Business or Trading Name

ABN (Optional) - Find it here

We are unable to assist with event, market stall or short term insurance (less than 12 months).

About Your Business Operations

How does your business operate?

Estimated annual turnover

Number of persons working in the business

Please detail your full business activities

Does your business employ Contractors and/or Sub-Contractors or Labour Hire personnel?

Do you ensure that Contractors, Subcontractors and/or Labour Hire personnel have their own liability and where necessary?

Amount paid to Sub-Contractors, Contractors or Labour Hire personnel?

Declaration and Duty of Disclosure

When you apply for an insurance policy, or renew or extend your existing policy, you have to tell the insurer everything about you and your situation that is relevant or could reasonably be expected to be relevant to the insurer’s decision to insure you. If you do not tell us something that is applicable to your insurance, the insurer may cancel your policy or reduce the amount that they will pay you if you make a claim, or both. If your failure to tell us is fraudulent, the insurer may refuse to pay a claim and make the policy contract void.

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Disclosure Questions and Claims History

1. Has the insured or any insured party ever had a claim declined or refused due to fraud, suspected fraud or suspicious circumstances?

2. In the last 5 years ever been placed in receivership or liquidation or declared bankrupt or are you in the process of being declared bankrupt?

3. Within the last 5 years, has the insured or any insured party been charged or convicted of a criminal offence?

4. Is any of the property in disrepair or in poor condition or are there any other facts that could affect the insurers assessment of the risk?

5. In the last 5 years, has the insured had any business-related claims?

If the answer is 'Yes' to any of the above questions, please enter full details below:

Your Contact Details

First Name

Last Name

Phone Number

Email Address

Postcode

Suburb

Optional: Save time and upload your current business insurance policy schedule.

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