• Public Liability Insurance Proposal

    Tell us about your business and we will find you a competitive quote. Once you have completed the form, click the Submit button to send your information.

    Your request for a quote will be handled promptly.

    Prefer to talk it through? You can call Liability Brokers during business hours to discuss your quote, or leave us a recorded message at the bottom of this form.

  • Client Details

  • Are you an existing client of Liability Brokers?*
  • Do You require cover for any subsidiary or associated company?*

  • Occupation

    Now we need to understand what you do in order to rate your risk

  • Quote Required

    Select the amount of cover you require

  • Public & Products Liability*

  • Underwriting Questions

  • Rows

  • NSW Small Business Stamp Duty Exemption

  • I declare that I/we are a small business eligible to seek a stamp duty exemption and have an aggregated turnover of less than $2 million.*

  • Notes:
    Aggregated turnover is your Australia wide annual turnover plus the annual turnovers of any business entities that are your affiliates or are connected with you.

    A fraudulent declaration may invalidate your insurance contract.

    The declaration covers all policies issued to you during the last financial year.

    An insurer will place reliance on your declaration in charging the applicable insurance duty

    False declarations may result in penalties up to $11,000 by Revenue NSW plus the Insurance duty not paid and penal interest on that balance.

    Revenue NSW may also be able to darify your queries relating to the law and your obligations.

     

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    Contractors

  • Do you employ contractors, subcontractors?*
  • Do they have their own Public Liability cover?
  • Do they have their own Workers Compensation cover?

  • Labour Hire

  • Do you use labour from labour hire companies?*

  • Risk Questions

  • Do you do welding or hot cutting activities away from own premises?*
  • Do you discharge waste or hazardous material into the atmosphere, sewer or elsewhere?
  • Do you, or do you intend to use, store or handle hazardous substances?
  • Do you import or export goods/products?*
  • Does the business perform work at mine sites, either above or below ground or provide products or services for use in the mining industry?*
  • Do you provide equipment out on hire?*
  • Does Your Business use explosives?*
  • Does Your Business work at heights exceeding 10 metres?*
  • Does Your Business carry out underground/excavation work exceeding 3 metres in depth?
  • Is your business involved in demolition activities?*
  • Do you provide services or products for use in the following areas?*
    • Aircraft / Airports / Airlines Radar installations
    • Bridge Construction or maintenance
    • Chemical Works, Petrochemical Plants
    • Dams
    • Oil or Gas Production, Pipelines, Offshore platforms
    • Public Utilities (ie Power Plants, Water, Communication)
    • Railways
    • Shipping / Port Authorities
    • Watercraft or Marine Vessels

  • Insured's History

  • Have you (or any person receiving cover under this policy) ever:*
    • Had insurance cancelled or declined by an Insurer?
    • Had a proposal rejected, renewal refused or claim rejected by an Insurer?
    • Had any special conditions imposed?
    • Suffered a loss whether insured or not (last 5 years only)?
    • Been declared bankrupt or insolvent or involved in a company that has declared bankruptcy or insolvency?
    • Been charged or convicted for a criminal offence?

  • Declaration

    By submitting this Declaration the Applicant acknowledges:

    • they are authorised by each of the other Applicants to make this Declaration,
    • the contents of the Declaration are true and complete,
    • they are under a continuing obligation to immediately inform the insurer of any change in the particulars or statements contained in this Declaration or in the accompanying documents up until the contract is entered into,
    • they authorise the insurer to give or obtain from other insurers or insurance reference bureaus or credit reporting agencies, any information about this insurance or any other insurance held by the Applicant/s.
  • Date
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  • Duty of Disclosure: What you must tell us
    Under the Insurance Contracts Act 1984 (the Act), you have a Duty of Disclosure. You are required before you enter into, renew, vary, extend or reinstate your Policy, to tell us everything you know and that a reasonable person in the circumstances could be expected to know, is a matter that is relevant to our decision whether to insure you, and anyone else to be insured under the Policy, and if so, on what terms.

    • You do not have to tell us about any matter
    • that diminishes the risk
    • that is of common knowledge
    • that we know or should know in the ordinary course of our business as an insurer, or
    • which we indicate we do not want to know.
    • If you do not tell us

    If you do not comply with your Duty of Disclosure we may reduce or refuse to pay a claim or cancel your Policy. If your non-disclosure is fraudulent we may treat this Policy as never having worked. 

     

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