Business Package
What do you need cover for?
Property Damage
Business Interruption
Theft
Glass
General Property
Breakdown
Public & Products Liability
Transit
Money
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Business Name
*
Business Address
Description of business activities
Number of years in business
Contact Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Claims Questions
Have you sustained any liability or property claims in the past 5 years?
Please Select
Yes
No
Are there any other facts that an insurer should be aware of?
Please Select
Yes
No
If yes to either of the above two questions please advise details:
Construction of premises
Walls
Please Select
Brick
Concrete
Timber
Metal
Other
Floor
Please Select
Concrete
Timber
Other
Roof
Please Select
Tile
Metal
Concrete
Other
Type a question
Security at Premises
Deadlocks on external doors?
Yes
No
Key locks on windows?
Yes
No
Alarm System?
Yes
No
Alarm monitored by security company?
Yes
No
N/A
Other Security Include fencing, security cameras, bars etc.
Fire protection at Premises
Fire Extinguishers?
Yes
No
Hose Reel?
Yes
No
Fire Hydrant?
Yes
No
Sprinklers?
Yes
No
Fire Alarm?
Yes
No
Smoke Detectors?
Yes
No
Breakdown
Please enter the sum insured for each of the following
Electrical Equipment:
Type of electrical equipment:
Machinery:
Type of Machinery:
Deterioration of Stock:
Public & Products Liability
Limit of Liability:
Please Select
$5,000,000
$10,000,000
$20,000,000
Annual Turnover:
Number of Employees:
Do you use contractors:
Yes
No
Do contractors have their own liability insurance?
Yes
No
N/A
What do contractors do for you?
Annual payments to contractors:
Submit
Should be Empty: