International Casualty Submission Form
Please fill out the following form. Upon completion, a member of the team shall be in contact within one working day.
HWS Specialty Privacy Notice
Broker Details
Unique Broker Code
If you are a member of the Steadfast Network, or an affiliated HWS Specialty broker, please enter your Unique Broker Code
Broker Name
*
Broker E-Mail
*
Back
Next
Insured and Business Profile
Name of Insured
*
Trading Name(s)
Sector
*
Financial Services
Professional Services
Construction & Contracting
Manufacturing
Wholesale, Distribution & Retail
Agriculture, Forestry & Fishing
Transport & Logistics
Information Technology
Healthcare & Social Assistance
Education & Training
Hospitality & Food Services
Real Estate & Property Management
Arts, Entertainment & Recreation
Utilities
Mining & Resources
Government & Public Administration
Other
If Other, please specify
Year established
Back
Next
Submission Details
Enquiry description
*
Territory(ies)
*
Expiring revenue
*
Supporting documentation
Upload a File
Drag and drop files here
Choose a file
e.g. Business Plan, Financial Statements, Organisation Chart
Cancel
of
Back
Next
Coverage and Policy Details
Inception date
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Coverage
*
General Liability
Products Liability
Pollution Liability
Environmental Impairment Liability
Workers’ Compensation
Umbrella Liability
Property Damage
Business Interruption
Professional Liability
Cyber Liability
Other
If Other, please specify
Limit of liability - Any one incident
*
Limit of liability - In the aggregate
*
Expiring premium
*
Back
Next
Claims and Risk Information
Loss runs (minimum 5 years)
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Loss record narrative
Risk management protocol
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: