Trades Insurance Fact Find

Trades Insurance Fact Find

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Contact Details:
Name:*

First NameLast Name
Date of Birth:*

DayMonthYear
Date
Business Name:*
ABN:*
Occupation:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Email:*
example@example.com
Are you currently insured?*

YesNo
If yes, please provide the name of your insurer and your the expiry date? *
If uninsured, please note n/a
Please your current premium?*
$$
Public/Products Liability Insurance:
Limit of Liability?*

$5 million$10 million$20 million
Excess:*
Full description of business activities:*
Estimated turnover?*
Estimated wages?*
Number of staff? (inc. Principals & Directors)*
Any welding (on premises or on site)?*

YesNo
Any subcontractors?*

YesNo
If Yes to the above, please provide type and turnover:
Years of experience in the business?*
Any contracts or agreements entered into?*

YesNo
Have you had any claims in the last 5 years? If Yes, please advise full details and total cost of claim:*
Tools Insurance:

Please answer the below questions if you would like a quote on tools insurance
Would you like a quote on your tools?*

YesNo
Please advise the total replacement cost for all tools ($$)*
Do any of your tools exceed $2,500 per item?*

YesNo
If Yes to the above, please provide a description and replacement cost per tool:
Do you hire in any equipment?*

YesNo
If Yes to the above, please provide more details:
Motor Vehicle Insurance:

Please answer the below questions if you would like a quote on your motor vehicle insurance
Would you like a quote on your motor vehicle insurance?*

YesNo
If Yes to the above, please provide Year, Make, Model & Rego:
Any Motor Vehicle claims in the last 5 years? If Yes, please provide more details:
Any fines, penalties or loss of license? If Yes, please provide more details:
Any non-standard accessories? If Yes, please provide details:
Optional Extras from Dealer not factory fitted. For example Window Tinting, Alloy Wheels, Tow Bar, Weather Shields, Bug Guards, Toolbox
Personal Accident & Illness Insurance:

Please answer the questions below if you would like a quote on Personal Accident & Illness Insurance
Would you like a quote on Personal Accident & Illness Insurance?*

YesNo
Height:
Weight:
Weekly wage sum insured you would like to insure for?
Do you require a quote for both accident and sickness?

AccidentSicknessBoth
Any pre-existing medical problems?
Are you a smoker or non-smoker?

SmokerNon-smoker
Duty of Disclosure
Do you have any criminal convictions?*

YesNo
Have you ever been declared bankrupt?*

YesNo
YOUR DUTY OF DISCLOSURE Before you enter into a contract of general insurance with an Insurer, you must disclose to the Insurer every matter that you know, or could reasonably be expected to know, that is relevant to the Insurer’s decision whether to accept the risk of the insurance, and if so on what terms. You must answer the specific questions truthfully and accurately and not misrepresent the nature of the risk to the insurer. The duty also applies when you seek to renew, extend or alter a policy. It applies up to the time the policy is renewed, extended or altered. NON-DISCLOSURE If you do not comply with your duty of disclosure, the Insurer may be entitled to reduce their liability under the contract in respect of a claim and/or cancel the contract. If your non-disclosure is fraudulent, the Insurer may decline the claim and may avoid the contract from its beginning. Do you understand your Duty of Disclosure?*

YesNo
Do you have anything to disclose? If Yes, please provide details:*
Should be Empty:

Trades Insurance Fact Find

Contact Details:

Public/Products Liability Insurance:

Tools Insurance:

Motor Vehicle Insurance:

Personal Accident & Illness Insurance:

Duty of Disclosure