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- Construction Material of the Walls?*
- Construction Material of the Floors?*
- Construction Material of the Roof?*
- Sandwich Paneling?*
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- Premises Equipped with a Sprinkler System*
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- Is the Premises Equipped with any of the following*
- Is the Premises Equipped with any of the following*
- Premises Connected to Town Water?*
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- Is the Building Heritage Listed?*
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- Does the business activities involve cooking?*
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- Is / Does your business*
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- Does the business import any of the following*
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- Does the business hire out any of the following?*
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- Do your operations include any of the following*
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- Limit any one loss*
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- Please provide the date your existing policy expires *
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- Ever had any insurance cancelled or declined or special terms imposed?*
- Ever been declared bankrupt?*
- 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)?*
- Been convicted of any criminal offence within the past 5 years (other than minor traffic convictions)?*
- Been liable for a civil offence or pecuniary penalty (exceeding $5,000)?*
- Aware of any matters not disclosed above that is relevant to the underwriters consideration of this insurance?*
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Format: 0000 000 000.
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- Is Postal Address the same as the Business Address
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- Do you require any further information on other insurances?
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- Should be Empty: