Company General Questions Proposer Operations First Name Last Name Unit Street City Postal Code Date of Birth Gender Male Female Have you had any claims in the last 5 years? Yes No Have you ever had insurance declined or special conditions imposed? Yes No Have you ever been convicted of a crime or declared bankrupt? Yes No General Questions Proposer Operations Insured Name Base of Operation What type of carrier are you? Principal Carrier Subcontractor Both Gross Freight Earnings Number of powered units hauling freight Radius of Operation 200km 450km 850km WA Wide Australia Wide List of Sections SECTION 1 - ROAD FREIGHT LIABILITY? SECTION 2 - ROAD FREIGHT CARRIERS INSURANCE? SECTION 3 - ROAD FREIGHT TERMINAL LIABILITY? (only available if section 1 chosen) SECTION 4 - ROAD FREIGHT ERRORS & OMISSIONS? (only available if section 1 chosen)
