Business Package Quote Form

Business Package Quote Form
Insured Name*
Contact name*
Email*
Retype email*
Telephone Number:
Business Risk Address of Property to be insured
Suburb
State
Post Code*
Prefer Monthly or Annual payments
Details about your business premises this is required to calculate your insurance premiums.
Building Construction Walls
Does Building contain EPS - Sandwich Foam Panel construction (Includes Structural or Non-structural) if so what %
Buildings Frame
Buildings Roof
Buildings Floor/s
Approximate year Built
Number Of Stories/levels
Is the business enclosed in a Shopping Centre
Do You have Deep frying and or Wok frying
Fire Protection

Fire alarm back to baseHard Wired Smoke AlarmsBattery smoke alarmsFire extinguishersFire hose reelNone-No Fire protection
Security Protection

Deadlocks all external doorsKey operated window locks all windowsBars or grills all windowsLocal alarmBack to base alarmNormal Key locks onlyNo SecuritySecurity Patrol
Any Hazardous Goods stored at property to be insured
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
ANNUAL TURNOVER*
TOTAL NUMBER OF WORKING DIRECTORS, PARTNERS AND EMPLOYEES*
Are You Owner & Occupier of Building
GLASS COVER (REPLACEMENT)
GLASS COVER
LARGEST PANE OF GLASS IN SQM
Glass Ground or above floor
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 Hours2) Money Outside Of Business Hours3) Money In Safe4) Money In private residence5) Damage to safe cover requiredOther
OR BLANKET COVER SUM INSURED
MACHINERY BREAKDOWN
MACHINERY BREAKDOWN
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*
Has the insured or any Directors had any criminal convictions in the last 10 years*
Has the insured or any Directors had a claim refused, insurance declined or any special conditions imposed in the last 5 years*
Is the insured or any Directors aware of anything that may lead to a claim*
CURRENT INSURER
Expiry Date of current Insurance or date to start cover

MonthDayYear
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 )
Should be Empty:

Business Package Quote Form

Details about your business premises this is required to calculate your insurance premiums.

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

Please provide some details of Sums insured or Cover required as this is required to calculate your insurance premiums

PROPERTY SECTION (FIRE & PERILS COVER)

BUSINESS INTTERUPTION (Covers Loss of gross profits and/or rental)

PUBLIC AND PRODUCTS LIABILITY

GLASS COVER (REPLACEMENT)

THEFT COVER

MONEY COVER

MACHINERY BREAKDOWN

HISTORY DETAILS ( if you answer yes to any of the below questions please provide further information in free text box below)

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 )