Online Annual Construction and Liability Insurance Renewal Declaration Form

Online Annual Construction and Liability Insurance Renewal Declaration Form

Renewal Form For Existing Policy Holders
Please completed to submit this form prior to your insurance policy expiry date, to ensure continuity of cover.

This form is required to assist us in assessing your required cover, reconciling the previous estimated turnover, and to provide you with the renewal for the coming 12 months.

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.

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.
Business Name/Insured*
ABN Number*
Website Address
Business Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Postal code search*
Number of Employees *
Building Activities
Business Occupation*
Total must equal 100%
Building Residential: New
Building Residential: Structural Alteration/Additions
Building Office/Commercial: New
Building Office/Commercial: Structural Alterations/Additions
Building Industrial: New
Building Industrial: Structural Alterations/Additions
Building Non-Structural: Refurb Fitout/Alterations
Other
Percentage for other
Will any project involve any of the following

1. Civil works including roadworks or pipelines with a total length greater than 500m, runways, dams bridges or railways2. Contract works underground (this is not applicable to foundation and basement construction for buildings)3. Contract works in, under or, over water4. Excavation works exceeding a depth of 6 metres or two basement levels5. Relocation, raising, lowering or restumping of existing buildings6. Contract works in, on, or around dilapidated or heritage listed structures7. Contract works in, or around airports, aerodromes, airstrips or any areas where aircraft take off or land8. Demolition only9. Construction or alteration of institutional, government, or religious buildings10. Design and construct where you will provide the design11. The lending of a builders licence to or by youNone of these
Please provide the corresponding question number and all relevant information to all questions answered "Yes"
Location of your projects
Total (must equal 100%)
NSW
VIC
QLD
SA
WA
TAS
ACT
NT
Other
Percentage of Other
Insurance Details

Please provide an estimate
Total of all contract values of all projects, to commence within the next 12 months*
Estimated Turnover
The largest contract value any one project*
Maximum construction period any one project*

12 Months18 Months24 MonthsGreater than 24 Months (Please specify)
Public Liability*

Not Required$10,000.000$20,000,000$50,000,000Other, please specify
Pre-Existing Structures*
Maximum Replacement / Reinstatement Cost any one Pre-Existing Structure**
Number of projects which involve a Pre-Existing Structure*
Employee Tools*
Total Sum Insured (Employee Tools)*
Tools and Equipment (other than Mobile Plant and Equipment)*
Total Sum Insured (Tools & Equipment)*
Mobile Plant and Equipment*
Total Sum Insured (Mobile Plant & Equipment)*
Display Homes *
Hired In Mobile Machinery and Equipment*
Total Annual Hire Costs**
Maximum Replacement Value of Hired Equipment at any one time*
Cover for Items and Materials provided by the Principal or Owner*
Maximum Value of Items supplied*
Pollution Liability*
Contractual Liability*
Commenced projects
Have you commenced any products during the last 12 months?
Configurable list*
Potential claims during the policy period

Are you aware of any of the following?
Please confirm if you have suffered any accidents or incidences that would give rise to a claim under this insurance?*

YesNo
Has there been any loss of, or damage to, the project works or materials or property belonging to others that have not been reported?*

YesNo
Have you become aware of any circumstance involving asbestos or pollution that might give rise to a claim against you by a third party?*

YesNo
If you have answered yes to any of the above please describe below*
To the best of your knowledge, having made appropriate enquiries, have you or any person with whom you are in partnership; (if the proposed insured in a company) have any of the company's directors or office holders*; (*registered company)
Have you ever suffered any losses or claims*

YesNo
Have you ever had any insurance cancelled or declined or special terms imposed?*

YesNo
Have you ever been charged or convicted of any criminal offence or declared bankrupt?*

YesNo
Been associated in any way with any: Outlaw Motorcycle Gang ("OMG") or any member of an OMG; Organised Crime Gang ("OCG") or any member of an OCG, or other illegal association?*

YesNo
Had a liquidator and/or receiver appointed and/or been placed into external administration?*

YesNo
Been a defendant in any civil court case?*

YesNo
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?*

YesNo
Please provide all relevant information to all questions answered "Yes".Please include where applicable, dates, insurance companies, amounts claimed, and other information that may be relevant to the consideration of this insurance*
Contact Details
Name

First NameLast Name
Is the Contact Postal Address the same as the Business Address?

YesNo
Postal Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Postal code search*
Phone Number
Please enter a valid phone number.
Email
example@example.com
Comments
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?

Office InsuranceManagement LiabilityLandlords CommercialLandlords ResidentialPublic LiabilityCyberMotor VehicleHome & ContentsMachinery & PlantTravelTrades InsuranceOther
* Mandatory Fields

Thank you for completing our online form.
We will endevour to contact you with your insurance details soon.
Should be Empty:

Online Annual Construction and Liability Insurance Renewal Declaration Form

Building Activities

Insurance Details

Commenced projects

Potential claims during the policy period

Contact Details

IMPORTANT INFO

Other Insurance Needs