CGIB Public Liability Form

CGIB Public Liability Insurance - Online Quote Form
Please complete the following information and submit this form to obtain a Public Liability insurance quotation for your business.

All information you provide must be correct, true, and accurate as incorrect or misleading information may alter our quote and jeopardise cover if you proceed with a policy.

Please ensure you read the CGIB Customer Information Page before filling out this form.
This includes essential documents such as our Financial Services Guide, General Advice Warning, Privacy Statement, and Duty of Disclosure.

Click on one of the following links if you would like to obtain a quote for another type of insurance product

Business Insurance

Trades Insurance

Please see our helpful video on Public & Products Liability Insurance for further infomation.

If you are having any issues completing this form please contact our office on: 1300 764 244 or 03 8841 4200 and one of our Team will be able to assist you.
INSURED'S Details
Business Name / Insured Name*
Business Occupation *
Business Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Postal code search*
Fully describe all the products and/or services your business provides*
Business Website Address
ABN Number
Estimated turnover for the next 12 months *
How many years has this business been in operation? *
Total Number of Staff*
PUBLIC & PRODUCTS LIABILITY

For amounts you become legally liable to pay as compensation for Personal injury or Property Damage as a direct result of an occurrence happening in connection with your business - subject to the Insurers PDS/Policy Wording
Please see our short video on Public & Products Liability Insurance for further infomation.
Sum Insured Required?*
Is / Does your business*

Employ sub contractorsUse labour hireIntend to import goodsIntend to export goodsHire out equipment or staffLicensed to sell alcoholNone of the above apply
Estimate the amount to be paid to contractors and subcontractors in the next 12 months*
Do you ensure that contractors and/or subcontractors have their own liability and where necessary, Workers Compensation insurance?*
Estimate the amount to be paid to labour hire firms in the next 12 months?*
What type/s of work do staff from labour hire firms perform for you?*
Imported Goods
Does the business import any of the following*

Medical/pharmaceutical/veterinary products (incl. medicines, instruments/equipment)Gases or air under pressureAny aircraft and/or aircraft componentsFirearms, fireworks, ammunition, explosives and/or their component partsSelf-propelled vehicles/rolling stock and/or critical components being structural components, driving equipment, wheel frame, brakes, steering equipment and tyresTobacco and/or vaping productsBlood and/or blood productsChemicals (incl. cosmetics, pesticides, insecticides, industrial chemicals)StockfeedCured and/or fermented meatProducts designed or clearly intended for children up to 4 years of ageToys, bicycles/tricycles and/or playground equipment (all ages)Mechanised sporting/gymnasium equipmentHydraulic lifting equipmentAny food products from China, Hong Kong, Taiwan or IndiaAny vitamins/supplementsSafety and/or personal protective equipmentAny product subject to an Australian mandatory safety standard / not compliant with Australian standardsNone of the above apply
If you answered Yes to "Intend to export goods" please provide further details *
Is there a Hire Agreement with a disclaimer or legal waiver in place that the hirer signs before hiring? *
Is all equipment checked and maintained after each hire?*
Equipment hired out
Does the business hire out any of the following?*

Medical or surgical equipmentWatercraftJumping castlesElevated work platforms / scaffoldingMotorised cutting / sawing equipmentSelf-propelled vehicles without an operatorNone of the above
Annual payment derived from activity by hired out staff *
Do your operations include any of the following*

Work at airports, railway, oil rigs, gas rigs, oil refineries, chemical refineries, mines or quarries, ship yardsWork with/on cooling towers, alarm systems or mainframe computersBoilers and/or compressors which require Government certificatesManufacture, distribution, storage, transportation, of chemicals or other toxic or harmful matterUse or storage of explosivesProvide any advice, design or professional services, whether or not a fee is charged for such advice, design or professional serviceConduct any weldingNone of the above apply
If yes to any of the above, please provide details*
PREVIOUS INSURANCE Details
Do you currently hold an insurance policy?*
Please provide the date your existing policy expires *

DayMonthYear
Date
Please select the name of the Insurer*
Provide existing insurer name*
Duty of Disclosure

Have you or any partner/s or director/s of the business
Ever had any insurance cancelled or declined or special terms imposed?*

YesNo
Ever been declared bankrupt?*

YesNo
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)?*

YesNo
Been convicted of any criminal offence within the past 5 years (other than minor traffic convictions)?*

YesNo
Been liable for a civil offence or pecuniary penalty (exceeding $5,000)?*

YesNo
Aware of any matters not disclosed above that is relevant to the underwriters consideration of this insurance?*

YesNo
Please provide all relevant information to all questions answered "Yes"*
Claims Experience
Any claims in the last 5 years under the sections to be insured?
Details of Claim/s *
CONTACT Details
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Is Postal Address the same as the Business Address

YesNo
Postal Address*

Street Address

Street Address Line 2

CityState

Post Code
Postal code search*
How did you find us?*
Please provide details
Comments / Additional Information
IMPORTANT INFO
By proceeding you agree to the Terms of Use of this site and that you have read and understood this Important Information about answering questions that we ask of you.
We will handle your personal information in accordance with our Privacy Policy.

Completion of this form does not put an insurance policy/cover in place - you will need to contact us to arrange insurance cover.
Other Insurance Needs
Do you require any further information on other insurances?

Management LiabilityLandlords CommercialLandlords ResidentialCyberMotor VehicleMachineryTravelLife InsuranceIncome Protection
* Mandatory Fields

Thank you for completing our online form.
We will endevour to contact you with your insurance details soon.
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CGIB Public Liability Insurance - Online Quote Form

INSURED'S Details

PUBLIC & PRODUCTS LIABILITY

PREVIOUS INSURANCE Details

Duty of Disclosure

Claims Experience

CONTACT Details

IMPORTANT INFO

Other Insurance Needs