Tradesman Package Quote Form

Tradesman Package Quote Form
Insured Name*
Contact name*
Email*
Retype email*
Telephone Number:
Business Risk Address of Property to be insured
Suburb
State
Post Code based*
Prefer Monthly or Annual payments
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 you are a Painter and do Commercial & residential painting 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
PUBLIC AND PRODUCTS LIABILITY
PUBLIC & PRODUCTS LIABILITY
ANNUAL TURNOVER*
TOTAL NUMBER OF WORKING DIRECTORS, PARTNERS AND EMPLOYEES*
GENERAL PROPERTY COVER (Cover for your Tools Of Trade)
TOOLS OF TRADE COVER
SUM INSURED YOU REQUIRE FOR YOUR TOOLS
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 any circumstance 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 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:

Tradesman Package Quote Form

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 you are a Painter and do Commercial & residential painting 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

PUBLIC AND PRODUCTS LIABILITY

GENERAL PROPERTY COVER (Cover for your Tools Of Trade)

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 )