Proposal Form

Public Liability Insurance for Consultants

Tell us about your business and if everything is straight forward a quote will be given at the end.

If you prefer to talk to a broker first, please call Liability Brokers during business hours to discuss quotes or you can leave a recorded message for us at the bottom of this form.
Insured Name*
Trading Name
ABN No
If applicabl;e
Full Address*
Please include number, street, town/suburb & postcode
Phone No.*
Email*
What is your Occupation*
eg/ Training Consultant
Please provide Us with a full description of Your business activities*
Public Liability Sum Insured*

$10,000,000$20,000,000
Underwriting Questions
How many employees in the business?*

1 person2 people3 people4 people5 or more (Manually rated - call our office for quote)
Manual Risk Exposure
This policy is not available for occupations that involve a manual risk exposure ie. if you are involved in performing manual labour or the supervision of manual tasks. This would include showing others how to perform manual works eg. how to lift goods.

If you job does involve manual risk, please click this link to complete the appropriate form - Public Liability Form
Does your job involve manual risk exposure?*

YesNo
Insured's History
Have you (or any person receiving cover under this policy) ever had insurance cancelled or declined by an Insurer?*

YesNo
Have you (or any person receiving cover under this policy) ever had a proposal rejected, renewal refused or claim rejected by an Insurer?*

YesNo
Have you (or any person receiving cover under this policy) ever had any special conditions imposed on a policy?*

YesNo
Have you (or any person receiving cover under this policy) ever suffered a loss whether insured or not (last 5 years only)?*

YesNo
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.
If you want to leave a message or have a query please hit RECORD. When you have finished, hit STOP.
Name of person making this declaration:*
Total Premium
Calculation
Your quote will be sent to the email address provided.

Please refer to this email for instructions on how to proceed.
Should be Empty: