Business Pack | Ultra Insurance Solution

Company or Insured Name

Trading As

Registered for GST

Yes No

ABN

Address

City/Suburb/Town

State

Postcode

Business Type

Is this a new business?

Yes No

Type of occupancy

Owner Occupier Rented

Age of building

Type of building

Interested Parties?

Yes No

Construction

Deadlocks on external doors?

Yes No

Keylocks/mesh on all opening windows?

Yes No

Alarm?

Fire Protection

Extinguishers Fire Blanket Monitored Fire Alarm Sprinklers

Is there any commercial cooking done on these premises?

Yes No

Are you licensed to serve alcohol?

Yes No

What is the latest time you trade to?

Annual Gross Turnover

No of Staff / Partners

Please select the cover you require

FIRE & SPECIFIED PERILS

Yes

BUSINESS INTERRUPTION

Yes

GENERAL & PRODUCT LIABILITY

Yes

BURGLARY

Yes

MONEY

Yes

GLASS

Yes

GENERAL PROPERTY

Yes

MACHINERY BREAKDOWN

Yes

COMPUTER & ELECTRONIC EQUIPMENT

Yes

In the last 5 years have you:

(A) had insurance refused, cancelled, declined or special terms imposed?

Yes No

(B) been declared bankrupt?

Yes No

(C) been convicted of a criminal offence?

Yes No

(D) suffered any loss or claims?

Yes No

Contact Number

Email address

Additional Information

Send a copy to email address:

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