Situation
(Address, State and Postcode)

Limit Required

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

Number of Years in Business

Number of Years Experience

Annual Turnover last financial year

Occupation Details
(please tick relevant boxes)

Staircases
Handrails
Fences & Gates
Non Structural Components
Structural Components ( Ballustrades/Beams/Framing etc)
Aircraft or Watercraft
Motor Vehicles or Trailers
Mining or Mining Equipment
Railway or Public Utility Risks
Chemical Sites
Petrol, Oil or Gas Production Facilities
Other, please advise details

Do you use Sub Contractors or Labour Hire Personnel?

yes no

If yes, do they have their own Liability Insurance?

yes no

Claims details - summary last 10 years

Ever been declined insurance?

yes no

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