Web Site General Questions Proposer Operations Contact person Company or Insured Name Mailing Address Registered for GST Yes No ABN Business Description Have you ever been convicted of a crime or declared bankrupt? Yes No Have you had any claims in the last 5 years? Yes No Have you ever had insurance declined or special conditions imposed? Yes No Do you employ subcontractors or use hire labour accounting for more than 25% of your total turnover? Yes No Does the business manufacture any products, including any alteration, assembly, repacking, labelling or decanting before distribution? Yes No Do you export products to USA/Canada? Yes No General Questions Proposer Operations Situation of Risk Situation Location Please select... Street Frontage (office / retail) Non street frontage (office / retail) Shopping centre (street frontage) Shopping centre (non-street frontage) Industrial / Commercial estate Outside metropolitan area Other Annual Gross Turnover Number of Staff Public Liability Sum Insured Please select... $5,000,000 $10,000,000 $20,000,000 Products Liability Sum Insured Please select... $5,000,000 $10,000,000 $20,000,000 Property in Physical or Legal Control: Please select... $100,000 $250,000 Interested Parties to note on policy Mobile Phone Number Additional Information Email address to send to
