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Tradies Fact Find Form
For Tradesperson's Public Liability, Motor, Personal Accident covers
Contact Person
*
First Name
Last Name
E-Mail
Email
Phone Number
Insured Name
For e.g. XYZ Pty Ltd or Sole Trader
ABN
*
Trading Name/Business Name
Referred by
*
Who introduced you to us?
Address
*
Street Address
Street Address Line 2
Suburb
State
Post Code
Business Description
*
Day to day business activities
Any other business activities?
Estimated Annual turnover
*
Gross income generated from all activities
Number of employees
*
Number of people engaged in business
Do you import any goods? If yes, please enter goods type and countries imported from?
Public Liability Cover
Limit of Liability
*
Please Select
$5mil
$10mil
$20mil
General property cover
Cover for your tools and equipment in the event of accidental damage or theft
Do you need cover for your tools in the event of theft or accidental damage?
Yes
No
Total value of tools under the value of $2,500 each
List of tools over $2,500 each.
Commercial Vehicle
Cover for you vehicles such as Utes, Vans or other business vehicle/equipment
Do you want quote for any of your commercial vehicles? Ute/Van/Truck etc.
Yes
No
Vehicle list
Personal Accident and Sickness Cover
Cover for your weekly income if you are not able to work in the event of injury or sickness
Do you want to cover your Income if you get injured/sick and not able to work for long period of time?
Yes
No
Date of Birth
-
Month
-
Day
Year
Date
Weekly earnings
Waiting period
Please Select
7 days
14 days
28 days
Benefit period
Please Select
1 year
2 years
5 years
Any pre-existing medical condition
Claims information
Have this business or any directors made any claims for the insurance covers applying for?
*
Yes
No
New business
Claims list
Duty of Disclosure
Ever had an insurance policy cancelled, declined or terms imposed?
*
Yes
No
Ever been declared bankrupt?
*
Yes
No
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)?
*
Yes
No
Been convicted of any criminal offence within the past 5 years (other than minor traffic convictions)?
*
Yes
No
Any other information that you want to provide?
Attach your current policy and/or claims history report.
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