Name: Enter your name here
Address: Enter the address of the property to be insured
Town or Suburb:
Post code:
Area code:
Phone number: Enter numbers only
State:
(Blank)
ACT
NSW
QLD
SA
TAS
VIC
WA
Email address: Enter your contact email address
Business name:
Enter the name of the business.
Do you conduct the business from more than one location?
Date the business commenced:
(dd/mm/yyyy)
Number of employees:
Provide the average number of employees working for the business.
FIRE
Business activities:
Describe the business activities carried on in the building.
Age of the building:
Indicate the approximate age of the building in years.
Walls:
Select the material the external walls are constructed of.
Brick
Concrete
Timber
Fibro
Mixed
Other materials
Roof:
Select the material the roof of the building is constructed of.
Concrete
Iron
Tiles
Glass
Fibro
Other materials
Floor:
Select the material the floor of the building is constructed of.
Concrete
Timber
Mixed
Other materials
Frames:
Select the material the frame of the building is constructed of.
Not applicable
Steel
Timber
Other materials
Type of building occupancy:
Select the type of building occupancy.
Owner occupier
Lessee
Shared premises
Property owner
Tennant
Fully sprinkled:
Partially sprinkled:
Hydrants & hose reels:
Alarms:
Extinguishers:
Smoke detectors:
Other fire protection:
Provide details of other fire protection measures.
Are hazardous goods stored in the building?
Building (s):
Contents, plant and machinery:
Stock, work in progress:
Customers goods:
Removal of debris:
Description of property:
Other property:
Total value: Replacement value to be insured
LIABILITY
Estimated gross annual turnover of the business:
Estimated annual payroll:
(a) in this business:
(b) in other businesses:
Do you require property owners' liability insurance?
Do you require liability cover for sub-contractors?
As part of your business activities, do you provide advice, separate to advice given that is associated with the business activities?
Public & Products Liability
Total value of property belonging to others that is in your physical and legal control:
BURGLARY
Are there deadlocks on all external doors?:
Are there key-locks on all windows?:
Are there bars and/or grills on all windows?:
Is there a local alarm attached to the building?:
Is there a "back to base" alarm system?:
If you have other types of security protection, please provide details:
All contents of the business (excluding stock, furniture, fixtures and fittings):
Stock:
Furniture, fixtures and fittings of the business:
Tools, equipment and computers used in the business:
Stock of cigarettes and liquor:
TOTAL VALUE TO BE INSURED:
Do you require cover for theft?:
By payment of an additional premium, you can extend the cover to include loss where there is no evidence of forced entry to the building.
OTHER TYPES
Loss of revenue:
(following loss or damage to assets by fire and specified events)
Loss of money and negotiable documents:
Breakage of fixed glass:
Loss of property that has been specified:
Loss resulting from employee theft:
Loss and/or breakdown of plant and machinery:
Loss and/or breakdown of computers and electronic equipment:
Loss or damage to goods in transit:
(within Australia)
Loss or damage to goods in transit:
(import/export)
Legal liability for injury to employees:
Other insurable business risks:
(professional indemnity; directors & officers' liability; construction; travel)
Employee group insurances:
(disability, trauma and life insurance programmes)
Employee income protection:
(Salary continuance cover following an accident or illness)
Superannuation:
(for employer-sponsored members or personal members)
