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TRADIE LIABILITY QUOTE FORM
Ten Seventy Pty Ltd t/a Reef Insurance Brokers is an Authorised Representative (AR # 1285127) of United Insurance Group (UIG) AFS Number 327131
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1
YOU HAVE A DUTY OF DISCLOSURE OBLIGATION
*
This field is required.
Ok, so before we start we need to tell you some things... Yes, it's boring, but it’s important and we need to do this - it only takes a minute. YOUR DUTY OF DISCLOSURE Before you enter into an insurance contract, you have a duty to tell the insurer anything that you know, or could reasonably be expected to know, that may affect the insurer’s decision to insure you and on what terms. NOTE: You have this duty until the insurer agrees to insure you. You have the same duty before you renew, extend, vary, or reinstate an insurance contract. You do not need to tell the insurer anything that: • reduces the risk they insure you for; or • is common knowledge; or • the insurer knows, or should know; or • the insurer waives your duty to tell them about. IF YOU DO NOT TELL THE INSURER SOMETHING If you do not tell the insurer anything you are required to, they may cancel your contract, or reduce the amount they will pay you if you make a claim, or both. If your failure to tell the insurer is fraudulent, they may refuse to pay a claim and treat the contract as if it never existed. DUTY TO NOT MAKE A MISREPRESENTATION NOTE: if you are applying for a new consumer insurance contract, renewing a consumer insurance contract or varying an existing consumer insurance contract, which is an insurance policy obtained wholly or predominately in relation to personal, domestic or household insurance purposes, you must answer the specific questions asked by the insurer truthfully and accurately. In answering those questions, you must tell the insurer all information that’s known to you and that a reasonable person would be expected to provide in answer to the questions. APPLYING FOR A NEW CONSUMER INSURANCE CONTRACT OR VARYING AN EXISTING CONSUMER INSURANCE CONTRACT. • You have a duty under the Insurance Contracts Act 1984 (ICA) to take reasonable care not to make a misrepresentation to the insurer (your duty). • Your duty applies only in respect of a policy that is a consumer insurance contract, which is a term defined in the ICA. • Your duty applies before you enter into the policy, and also before you renew, extend, vary, or reinstate the policy. • Before you do any of these things, you may be required to answer questions and the insurer will use the answers you provide in deciding whether to insure you, and anyone else to be insured under the policy, and on what terms. To ensure you meet your duty, your answers to the questions must be truthful, accurate and complete. • If you fail to meet your duty, the insurer may be able to cancel your contract, or reduce the amount it will pay if you make a claim, or both. • If your failure is fraudulent, the insurer may be able to refuse to pay a claim and treat the contract as if it never existed.
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2
When do you need your policy to start?
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We can't back date policy, but we can change the start date - so if you are not sure - choose today...we can sort this out later.
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Date
DD
MM
YYYY
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3
Are you...?
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a Sole Trader
a Company
a Partnership
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4
What’s your company name?
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This is the name you registered for your ABN.
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5
Do you have a trading name?
If not, just leave this field blank
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6
What’s your ABN?
Not sure...leave this field blank - we can look it up for you.
if required
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7
You’re doing great! Please tell us your name?
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First Name
Last Name
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8
What’s your business address?
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We need a street address, not a PO Box please? That's the next question.
Street
Street Address
Suburb
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QLD
NSW
ACT
VIC
TAS
WA
NT
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QLD
NSW
ACT
VIC
TAS
WA
NT
State
Post Code
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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9
Do you have a postal address?
Leave this blank if you don't have a separate postal address.
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10
What’s your phone number?
*
This field is required.
This is kind of important - we need this one completed. We might need t call you.
Area Code
Phone Number
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11
What’s your email?
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This field is required.
So we can email you your quote....
example@example.com
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12
Please choose an occupation that best describes what you do?
*
This field is required.
Not on the list? Choose "Other - my Occupation is not listed" & you can tell us what you do on the next question.
Antenna / Satellite Installation (up to 10 metres)
Antenna / Satellite Installation (no height restriction)
Alarm / CCTV Installer
Air-cond / Refrideration Mechanic (including Sales & Installation)
Auto / Car Detailer
Audio Visual Installer
Awning Installations
Awning & Shade Sail Installations
Bathroom Installations (including shower screens)
Boilermaker / Welder / Metal Fabrication (including Structural)
Boilermaker / Welder / Metal Fabrication (excluding Structural)
Bricklayer
Builder (up to 10 metres)
Builder (no height restriction)
Building or Property Maintenance (Handyman)
Cabinet Maker (including Installation)
Carpenter
Carpet Layer / Floor Coverings Installation
Cleaner (Domestic Only)
Cleaner (Domestic & Office Only)
Cleaner (Commerical - After Hours)
Cleaner (Commercial - Operational Hours)
Concreter / Concrete Pourers (including Formwork, Repairs & Drilling)
Curtain / Blind Installation
Dog Groomer / Dog Walker / Pet Sitter
Earthmoving & Excavation
Electrician (Qld)
Electrician (excluding Qld)
Farmhand Contractor
Fencing Contractor
Fire Alarm / Extinquisher Service Contractor
Furniture Removalist & Storage (Domestic Only)
Furniture Removalist & Storage (Domestic & Commercial)
Garage Door Installations
Garage Door Installation (including Service & Maintenance)
Gardener / Landscaper
Gas Fitter (Domestic Only)
Gas Fitter (Domestic & Commercial)
Glazier
Handyman
Interior Designer
Irrigation Installation (including Sales & Service)
Kitchen Installer (including Gas Works)
Kitchen Installer (excluding Gas Works)
Lawn Mowing & Garden Maintenance
Locksmith (Domestic only)
Locksmith (Domestic & Commercial)
NBN / Telecomunications Contractor & Installer
Painter (up to 10 metres)
Painter (no height restricition)
Partitioning Contractor
Paving Contractor
Plasterer
Plumber (Domestic Only)
Plumber & Gas Fitter (Domestic Only)
Pool Cleaning & Maintenance
Powder Coating / Spray Painting / Protective Coatings Contractor
Rendering Contractor
Roofer
Sandblasting Contractor
Security Door / Screen & Shutters Installer
Signwriter (including Installation)
Shed Installations
Shelving & Racking Installations
Shop & Office Fitters
Skylight Installations
Solar Panel Installation (including Maitenance & Repairs)
Stonemason
Tiler (Floor/Walls)
Upholsterer
Waterproofing Contractor
Window Cleaner (up to 10 metres)
Window Cleaner (no height restriction)
Welder (excluding Structural)
Welder (including Structural)
Other - my Occupation is not listed
Antenna / Satellite Installation (up to 10 metres)
Antenna / Satellite Installation (no height restriction)
Alarm / CCTV Installer
Air-cond / Refrideration Mechanic (including Sales & Installation)
Auto / Car Detailer
Audio Visual Installer
Awning Installations
Awning & Shade Sail Installations
Bathroom Installations (including shower screens)
Boilermaker / Welder / Metal Fabrication (including Structural)
Boilermaker / Welder / Metal Fabrication (excluding Structural)
Bricklayer
Builder (up to 10 metres)
Builder (no height restriction)
Building or Property Maintenance (Handyman)
Cabinet Maker (including Installation)
Carpenter
Carpet Layer / Floor Coverings Installation
Cleaner (Domestic Only)
Cleaner (Domestic & Office Only)
Cleaner (Commerical - After Hours)
Cleaner (Commercial - Operational Hours)
Concreter / Concrete Pourers (including Formwork, Repairs & Drilling)
Curtain / Blind Installation
Dog Groomer / Dog Walker / Pet Sitter
Earthmoving & Excavation
Electrician (Qld)
Electrician (excluding Qld)
Farmhand Contractor
Fencing Contractor
Fire Alarm / Extinquisher Service Contractor
Furniture Removalist & Storage (Domestic Only)
Furniture Removalist & Storage (Domestic & Commercial)
Garage Door Installations
Garage Door Installation (including Service & Maintenance)
Gardener / Landscaper
Gas Fitter (Domestic Only)
Gas Fitter (Domestic & Commercial)
Glazier
Handyman
Interior Designer
Irrigation Installation (including Sales & Service)
Kitchen Installer (including Gas Works)
Kitchen Installer (excluding Gas Works)
Lawn Mowing & Garden Maintenance
Locksmith (Domestic only)
Locksmith (Domestic & Commercial)
NBN / Telecomunications Contractor & Installer
Painter (up to 10 metres)
Painter (no height restricition)
Partitioning Contractor
Paving Contractor
Plasterer
Plumber (Domestic Only)
Plumber & Gas Fitter (Domestic Only)
Pool Cleaning & Maintenance
Powder Coating / Spray Painting / Protective Coatings Contractor
Rendering Contractor
Roofer
Sandblasting Contractor
Security Door / Screen & Shutters Installer
Signwriter (including Installation)
Shed Installations
Shelving & Racking Installations
Shop & Office Fitters
Skylight Installations
Solar Panel Installation (including Maitenance & Repairs)
Stonemason
Tiler (Floor/Walls)
Upholsterer
Waterproofing Contractor
Window Cleaner (up to 10 metres)
Window Cleaner (no height restriction)
Welder (excluding Structural)
Welder (including Structural)
Other - my Occupation is not listed
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13
Ok, so you’re not on the list. Please tell us what you do?
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14
How many skilled employees do you have? (including you and sub-contractors)
e.g.: employees - 2 + 5 contractors
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15
Do you require cover for your sub-contractors?
Yes
No
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16
What's your 'guestimated' annual turnover?
*
This field is required.
This is your whole income before expenses & tax.
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17
What % if your turnover is generated by your sub-contractors?
*
This field is required.
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18
What Liability limit do you want?
*
This field is required.
(5 Million - not recommended)
10 Million
20 Million
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19
Do you want theft & damage cover for your tools?
Nope, I'm good thanks
Yep, lets get a quote
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20
Great choice! How much cover do you want for your tools?
$2,500
$5,000
$7,500
$10,000
$15,000
$20,000
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21
Have you made any claims for your tools in the last 5 years?
No
Yes
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22
Ok, please tells us about the claim for your tools?
We need info on what happened, & the cost of the claim please.
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23
Almost done... In the past 5 years has anyone lodged a Liability claim against you?
*
This field is required.
Yes
No
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24
Tell us about your claims history?
We are going to need the appoximate year, details of the claim was for, the outcome & if the claim finalised or still ongoing?
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25
Are you aware of anything that might cause someone to lodge a claim against you in the future?
*
This field is required.
Yes
No
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26
Ok, tell us what’s happened & why do you think it might become a claim?
Please provide as much detail as possible.
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27
Have you, in the past 5 years... been charged or convicted of a criminal offence, been prosecuted under any health and safety legislation (or similar) or been declared bankrupt or gone into liquidation or been refused insurance?
No
Yes
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28
Ok, no judgment here...we are going to need a few details and will likely give you a call too.
e.g.: Lets start with the year and brief details of what happened and the outcome.
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29
Do you want us to call you about any of the following policy types?
No strings attached - we can have a look at your other policies for you and provide a quote or explain what you are actually covered for...what have your got to lose? Pick as many you like and we will call you for the details.
My Ute / Truck / Car
Management Liability + Employment Liability Insurance
Equipment or Machinery Breakdown
Mobile or Heavy Machinery Insurance
Income Protection + Trauma Insurance
Contract Works + Material Damage Insurance
Home / Renters or Landlords Insurance
No, thanks...I'm good
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30
Perfect...you’re all done! Before you hit that submit button please let us know where you heard about us?
A Friend
Yellow Pages
Facebook
Local Google Search
Existing Client
Other
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