Business Insurance- Needs Assessment
Fill the fields below accurately and we will contact you back to you in a short time
Contact Person
*
First Name
Last Name
E-Mail
*
Contact Number
*
Format: (000) 000-0000.
Company Name/ To be insured entity
*
ABN
*
Business Insurance Sections you need a quote on
*
Property Damage- Building
Property Damage- Contents
Public & Products Liability
Theft/ Burglary
Machinery Breakdown
Glass
Money
Business Interruption
Workcover
Tax Probe
General Property/ Tools
Other
Business Description
*
Business Address including post code
*
Estimated Turnover per Annum
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Property Damage- Building- Amount in $$
*
If you own the building or are responsible to insure the Building
Property Damage- Contents & Equipment - Amount in $$
*
How much would it take to replace- Fit outs- Fixtures, Contents, Equipment & Stock
Theft/ Burglary Amount to be insured
*
Money $$ to be insured
*
Business Interruption- Gross Profit- $$ to be insured
*
General Property/ Tools- $$ to be insured
*
Tell us more about your premises- Select All the applicable
*
Fire Extinguishers
Fire Alarm
Fire Sprinklers
Security Alarm
CCTV
Monitored Alarm
Local Alarm
Single Storey
Shopping Centre
Industrial Area
Street Frontage
Deep Frying
Other
Your background- History-Disclosure Questions in last 5 years
*
Any Claims/Incidents
Criminal History
Any Bankruptcy History
Insurance declined
Other
Any Interested Party:
*
Financier/ Lessor/ Shopping Centre Management etc
Do you use sub contractors, if yes, how much paid yearly to them:
*
If no, write $0
Year of the construction
*
If no, write $0
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