Public Liability Quick Quote

Full Name of Insured

Base of Operation

Inception Date

Limit Required

$5,000,000
$10,000,000
$20,000,000

Number of Years in Business

Number of Years Experience

Number of Years in Business

Number of Years Experience

Estimated Annual Turnover

Occupation Details
(please provide a full description of your business activities)

Show percentage of work performed in each state

NSW %

ACT %

VIC %

TAS %

QLD %

WA %

SA %

NT %

Do you use Sub Contractors?
(if yes, please provide details of work completed by Sub Contractors)

yes
no

Do you use Labour Hire Personnel?
(if yes, please provide details of work completed by Labour Hire Personnel)

yes
no

Do you import?

yes
no

Do you export?

yes
no

If yes to importing or exporting, please provide details

Number of staff

Wages

Claims details - summary last 10 years

Ever been declined insurance?

yes
no

Comments

PLEASE NOTE This is for the use of NON BINDING INDICATIVE QUOTATION PURPOSES ONLY and is subject to a satisfactorily completed Proposal Form Prior to Binding

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Brisbane

Beijing

Zurich

London

New York

Broker Details

Insured's Details

Brisbane

Beijing

Zurich

London

New York

Public Liability Quick Quote

Broker Details

Insured's Details

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