Contractor Insurance

Contractor Insurance
CONTRACTOR’S STATEMENT REGARDING INSURANCE COVERAGE AND LICENSING INFORMATION
You are in receipt of this document for the purpose of supplying the Scifleet Group of Companies evidence of sufficient insurance and public liability coverage and licensing information (where applicable) for conducting designated works at our sites.

At all times you must have current and suitable insurance / public liability coverage and licensing (where applicable) for the tasks undertaken.

Please complete the following statement and return via email together with copies of your current policies / licensing. Please also sign the declaration at the base of this form.
Public Liability Insurance
Public Liability Insurance Provider:*
Policy Number:*
Limit of Coverage (for any one occurrence):*
Date of Expiry:*
Please also supply a copy of public liability insurance cover:*

Cancelof
Workers Compensation Insurance
Workers Compensation Insurance Policy Number:
Date of Expiry:
Please also supply a copy of workers compensation insurance cover:

Cancelof
Please check the box if you are also required to provide copies of licensing / certification:

Yes
If you selected 'Yes', please provide copies of licensing/certification:

Cancelof
Declaration of Information
I declare that the information provided by myself with respect to insurance coverage / licensing information is true and correct and I will not undertake any work at Scifleet Group of Companies premises without the insurance cover / licensing (where applicable) listed above or without notifying the group’s Compliance Manager of any alterations to the policies listed above. I also undertake to ensure the ongoing currency of insurance policies and licensing (where applicable).
Your Name:*

First NameLast Name
Company Name:*
Title:*
Email:*
Today's Date:*
Signature:*

Clear
This form can be returned once complete with supporting documentation to email address compliance@scifleet.com.au

Any queries contact Paul Willman on 0424 505 573.
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Contractor Insurance

CONTRACTOR’S STATEMENT REGARDING INSURANCE COVERAGE AND LICENSING INFORMATION

Public Liability Insurance

Workers Compensation Insurance

Declaration of Information