Public & Products Liability Quote
To make sure we understand your business and provide you with an accurate quote, we do need to ask you some questions. If you would prefer to speak to a qualified broker, please call us on 07 5600 0192.
Business Details
Policy start date
*
-
Day
-
Month
Year
Date
Does the business currently have Public & Products Liability in force that has been paid for?
*
Please Select
Yes - Existing business with current insurance via direct insurer
Yes - Existing business with current insurance via a broker
No previous insurance (existing business)
No previous insurance (new venture)
Please specify current insurer name:
Legal Entity / Insured Name (include business name and trusts if applicable)
*
ABN
*
Website Address
Main Business Address/Location
*
Street Address
Street Address Line 2
Suburb
State
Post Code
Are you the property owner?
*
Yes
No
Does the total floor area exceed 1,000m2?
Are you eligible for any Stamp Duty exemptions?
*
Yes - NSW Insurance Duty Exemption
Yes - Stamp Duty Exemption (Other)
Describe, in full, your business activities:
*
Details of any licences/qualifications if applicable:
Do you need to note any Interested Parties (e.g. Landlord, Local Govt. Authority)?
Estimated gross annual turnover (next 12 months) $
*
Total number of full time equivalent employees (incl. directors)
*
Total number of part-time/casual staff
*
Estimated gross annual wages (next 12 months) $
In which state(s) does the business generate turnover?
*
QLD
NSW
VIC
WA
ACT
SA
TAS
NT
Do you intend to engage in any overseas activities in the next 12 months?
*
Yes
No
Duty of Disclosure / Insurance History
Have you or any partner(s) or director(s) of the business, ever had an insurance policy cancelled, declined or terms imposed?
*
Please Select
Yes
No
Have you or any partner(s) or director(s) of the business, ever been declared bankrupt?
*
Please Select
Yes
No
Have you or any partner(s) or director(s) of the business, ever been involved in a company or business which became insolvent or subject to any form of insolvency or voluntary administration (e.g. liquidation or receivership)?
*
Please Select
Yes
No
Have you or any partner(s) or director(s) of the business, ever been convicted of any criminal offence within the past 5 years?
*
Please Select
Yes
No
Have you or any partner(s) or director(s) of the business, ever been liable for any civil pecuniary penalty (exceeding $5,000)?
*
Please Select
Yes
No
Have you or any partner(s) or director(s) of the business, had any Liability claims in the last 3 years?
*
Please Select
Yes
No
Public & Product Liability Information
What Public & Products Liability limit would you like to insure?
*
$10,000,000
$20,000,000
Are your business activities wholly undertaken within an office environment?
*
Yes
No
Dos the business do any manual work away from the premises?
*
Yes
No
If work is performed away from your premises, please describe the type of work undertaken & estimate % of turnover:
Do you import any products?
*
Yes
No
If Yes, please advise a) type of products imported, b) Countries products are imported from, c) Annual value of products $, and d) % of turnover derived from imported products
In the last 6 years or in the future, do you intend to undertake business or export to any of the following countries - Belarus, Burma (Myanmar), Cote d'lvoire, Cuba, The Democratic Republic of the Congo, Iran, Iraq, Liberia, North Korea, Sudan, Syria or Zimbabwe?
*
Yes
No
Do you or do you intend to export any products?
*
Yes
No
If Yes, please advise a) type of products exported, b) Countries products are exported to, c) Annual value of products $, and d) % of turnover derived from exported products
Do you engage contracts or sub-contractors in your business?
*
No
Yes - labour only
Yes - labour and plant
Yes - labour, plant and materials
If yes, please advise a) type of work they perform for you, b) estimated amount to be paid to contractors/sub-contractors in the next 12 months, and c) do you ensure they have their own liability insurance.
Do you engage labour hire or hire in labour in your business?
*
Yes
No
If Yes, please advise a) type of work staff from labour hire firms perform for you, and b) estimated amount to be paid to labour hire firms in the next 12 months.
Do you have any contracts to be designated?
*
Please Select
Yes
No
Do you, or do you intend to use, store or handle hazardous substances?
*
Please Select
Yes
No
Do you discharge waste or hazardous material into the atmosphere, sewer or elsewhere?
*
Please Select
Yes
No
Do you perform "hot work" away from own premises that involves the use of cutting, welding, grinding or soldering equipment?
*
Please Select
Yes
No
Do you require cover for testing and/or delivery of vehicles (driving risk)?
*
Yes
No
Equipment Hired Out
Do you hire out equipment and/or staff?
*
Yes
No
If Yes, do you remain onsite whilst the items are being hired?
If Yes, who is responsible for set-up and pack down of items?
If Yes, is there a hire agreement with a disclaimer or legal waiver in place that the hirer signs before hiring?
If Yes, is all equipment checked and maintained after each hire?
Please describe equipment hired out and turnover derived $
Please advise annual payment derived from activity by hired staff $
Business Exposures
Does the business hire out any of the following: (please tick all that apply)
*
medical or surgical equipment
watercraft
jumping castles
elevated work platforms/scaffolding
temporary security fencing
motorised cutting/sawing equipment
self-propelled vehicles without an operator
children's play gyms, play equipment, seating, toys or furniture
none of the above
Does the business manufacture any products, including any alteration, assembly, repacking, labelling, mixing or decanting?
*
Yes
No
Does the business, or do you expect the business to: (please tick all that apply)
*
manufacture smallgoods or fermented meats
sell products intended for use for children and/or babies
sell products containing Bisphenol A (BPA)
sell products at local markets / attend market stalls
sell products containing food or alcohol
use a commercial deep fryer or wok or wood fire oven
use a benchtop deepfryer
do any work involving spray painting outdoors
do any work inside a ventilated spray booth
carry out any underground/excavation work exceeding 5m in depth
carry out any height work exceeding 2 storeys
do any work involving tree lopping / felling activities
carry out any work involving drones
carry out any restumping, reblocking, underpinning or piling work
none of the above
Does the business perform, arrange, accept responsibility for or; has the business performed, arranged or been responsible for; any work at or on or involving any of the following: (please tick all that apply)
*
aviation or parts of airports used by aircraft for loading and unloading and takeoffs and landings
civil works
offshore platforms and rigs
watercraft exceeding 8m in length
underground mine shafts or tunnels
demolition of buildings or other structures exceeding 5m in height
subaqueous / underwater work
marine (including underwater activities)
marine (including oil and gas exploration)
chemical
automative
railway, railway signalling or working within rail corridors
construction and/or structural maintenance of dams/reservoirs or weirs
medical/pharmaceutical
defence/munition
blasting or use of explosives or detonation devices
dry hire (hire out equipment that is self-propelled without an operator)
power/transmission lines or substations
petrochemical plants or refineries
public utilities
public infrastructure (including footpaths, roads, bridges and/or tunnels)
installation, repair, servicing, maintenance or cleaning of cooling towers
none of the above
Do you have documented quality control procedures in place?
*
Yes
No
Do your products comply with the applicable Australian and/or International Standard(s)?
*
Yes
No
N/A
Your Contact Details
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
I understand and accept Status Insurance Brokers Website Terms of Use, Privacy Policy and Financial Services Guide. A copy of the Product Disclosure Statement and applicable Endorsements will be provided to you during the quotation process.
*
Yes
Is there anything else you think we should know?
Submit
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