Product Recall Insurance Scheme Questionnaire

Product Recall Insurance Scheme Questionnaire
Company Name*
ABN*
Head Office Address*
Under $5m$5m - $10m$10m to $20mHigher than $20m
Please provide a description of your products (ie. LED Lighting)*
ResidentialCommercialIndustrialOther
If other, please provide details*
Please list the country/countries of manufacture for your products*
YesNo
If no, please provide information why.*
YesNo
Insurance Cover

Please select the types of cover you would like included as part of the Product Recall insurance program. Hover over headings for a description of the cover.
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Quality Control Information
Please provide a summary to allow us to understand your Quality Control process including pre-shipping and upon receipt of goods.*
Please attach any documentation to support, or a further description (if required) of your quality control procedures.

Cancelof
Signature

Clear
Name - Please provide your first and last name.*
Email*
Contact Phone Number:*
Please press ‘SUBMIT’ once completed and a copy will be sent automatically to Benjamin & Benjamin.

If you have any questions, please contact Richard Cholewick by email (richard@benjamin-ig.com.au) or call on 0499 038 566.
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Insurance Cover