Trades Insurance Fact Find
If you need any assistance with completing this form, please call us on 07 3491 6532
Contact Details:
Name:
*
First Name
Last Name
Date of Birth:
*
-
Day
-
Month
Year
Date
Business Name:
*
ABN:
*
Occupation:
*
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
-
Area Code
Phone Number
Email:
*
example@example.com
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)?
*
Yes
No
Any subcontractors?
*
Yes
No
If Yes to the above, please provide type and turnover:
Years of experience in the business?
*
Any contracts or agreements entered into?
*
Yes
No
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?
*
Yes
No
Do any of your tools exceed $2,500 per item?
*
Yes
No
If Yes to the above, please provide more details:
Do you hire in any equipment?
*
Yes
No
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?
*
Yes
No
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?
*
Yes
No
Height:
Weight:
Weekly wage sum insured you would like to insure for?
Do you require a quote for both accident and sickness?
Accident
Sickness
Both
Any pre-existing medical problems?
Are you a smoker or non-smoker?
Smoker
Non-smoker
Duty of Disclosure
Do you have any criminal convictions?
*
Yes
No
Have you ever been declared bankrupt?
*
Yes
No
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?
*
Yes
No
Do you have anything to disclose? If Yes, please provide details:
*
Submit
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