Business Package Quote Form
Insured Name
*
Contact name
*
Email
*
Retype email
*
Telephone Number:
Business Risk Address of Property to be insured
Suburb
State
Please Select
NSW
QLD
VIC
WA
SA
NT
TAS
Post Code
*
Prefer Monthly or Annual payments
Please Select
Annual
Monthly
Details about your business premises this is required to calculate your insurance premiums.
Building Construction Walls
Please Select
Double Brick
Brick Veneer
Besa Block
Tilt Slab
Fibro
Timber
Steel
Colourbond
Other (please provide more info)
Mixed (please provide more info)
Does Building contain EPS - Sandwich Foam Panel construction (Includes Structural or Non-structural) if so what %
Please Select
YES
Less than 15%
Less than 20%
30% to 50%
Greater than 50%
NO - BUILDING HAS NO EPS
Buildings Frame
Please Select
Brick
Besa Block
Tilt Slab
Timber
Steel
Other (please provide more info)
Mixed (please provide more info)
Buildings Roof
Please Select
Tile
Iron
Concrete
Timber
Abestos
Colourbond
Fibro
Other (please provide more info)
Mixed (please provide more info)
Buildings Floor/s
Please Select
Concrete
Timber
Tiled
Other (please provide more info)
Mixed (please provide more info)
Approximate year Built
Number Of Stories/levels
Is the business enclosed in a Shopping Centre
Please Select
YES
NO
Do You have Deep frying and or Wok frying
Please Select
NO DEEP FRYING OR WOK COOKING
YES DEEP FRYING HOLDS UNDER 10 LITERS
YES DEEP FRYING HOLDS 10 TO 20 LITERS
YES DEEP FRYING HOLDS 20 TO 40 LITERS
Other (please provide more info)
Mixed (please provide more info)
Fire Protection
Fire alarm back to base
Hard Wired Smoke Alarms
Battery smoke alarms
Fire extinguishers
Fire hose reel
None-No Fire protection
Security Protection
Deadlocks all external doors
Key operated window locks all windows
Bars or grills all windows
Local alarm
Back to base alarm
Normal Key locks only
No Security
Security Patrol
Any Hazardous Goods stored at property to be insured
Please Select
YES
NO
Please give FULL Business description and business activities as this is required to calculate your insurance premiums. Please give % of business activities for example if sell wholesale and retail what % of your business is for each
Business Description & Business activities
*
Please provide some details of Sums insured or Cover required as this is required to calculate your insurance premiums
PROPERTY SECTION (FIRE & PERILS COVER)
BUILDING SUM INSURED
CONTENTS SUM INSURED
STOCK SUM INSURED
BUSINESS INTTERUPTION (Covers Loss of gross profits and/or rental)
ANNUAL GROSS PROFITS SUM INSURED
ANNUAL LOSS OF RENT SUM INSURED
ACCOUNTANT PREPARATION FEES
INCREASE COST OF WORKING COVER
PUBLIC AND PRODUCTS LIABILITY
PUBLIC & PRODUCTS LIABILITY
Please Select
$5,000,000
$10,000,000
$20,000,000
ANNUAL TURNOVER
*
TOTAL NUMBER OF WORKING DIRECTORS, PARTNERS AND EMPLOYEES
*
Are You Owner & Occupier of Building
Please Select
NO - Property Owner Only
YES - Owner & Occupier
YES - Occupy along with other tenants
GLASS COVER (REPLACEMENT)
GLASS COVER
Please Select
YES - Internal & External
YES - External Only
NO - (No glass cover required)
LARGEST PANE OF GLASS IN SQM
Please Select
< 5 SQ METERS
> 5SQ < 8 SQ METERS
> GREATER THAN 8SQ METERS
Glass Ground or above floor
Please Select
Ground Floor only
Ground Floor & Above Floor
Above Floor Only
THEFT COVER
THEFT OF CONTENTS SUM INSURED
THEFT OF STOCK SUM INSURED
THEFT OF TABACCO SUM INSURED
MONEY COVER
THEFT OF MONEY SUM INSURED
COVERS REQUIRED
1) Money During Business Hours
2) Money Outside Of Business Hours
3) Money In Safe
4) Money In private residence
5) Damage to safe cover required
Other
OR BLANKET COVER SUM INSURED
Please Select
YES
NO
MACHINERY BREAKDOWN
MACHINERY BREAKDOWN
Please Select
YES
NO
IF YES TO MACHINERY BREAKDOWN PLEASE LIST ITEMS, SIZE OF MOTOR & REPLACEMENT SUM INSURED
DETERIORATION OF STOCK COVER DUE TO BREAKDOWN SUM INSURED
HISTORY DETAILS ( if you answer yes to any of the below questions please provide further information in free text box below)
Has the insured or any Directors had any claims in the last 5 years
*
Please Select
YES
NO
Has the insured or any Directors had any criminal convictions in the last 10 years
*
Please Select
YES
NO
Has the insured or any Directors had a claim refused, insurance declined or any special conditions imposed in the last 5 years
*
Please Select
YES
NO
Is the insured or any Directors aware of anything that may lead to a claim
*
Please Select
YES
NO
CURRENT INSURER
Expiry Date of current Insurance or date to start cover
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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Day
Please select a year
2024
2023
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Year
ANY OTHER INFORMATION PLEASE USE THIS TEXT BOX
ANY OTHER BUSINESS PACK SECTIONS YOU WOULD LIKE A QUOTE ON ? SUCH AS GENERAL PROPERTY,COMPUTER & ELECTRONCI EQUIPMENT BREAKDOWN, TAXATION INVESTIGATION, EMPLOYMENT DISHONESTY. PLEASE LIST AND WE WILL CONTACT YOU TO DISCUSS COVER YOU REQUIRE OR PLEASE TYPE DETAILS IN TEXT BOX
ANY OTHER INSURANCE YOU WANT QUOTES ON SUCH AS BUSINESS,MOTOR, LANDLORDS, HOME & CONTENTS, WORKERS COMPENSATION PLEASE USE THIS TEXT BOX
DUTY OF DISCLOSURE ( Please check all details correct as quotes and any cover arranged will be based on the information you provide in this form non disclosure or incorrect information can affect if a claim is accepted or not )
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