Trades and Services Insurance Application

By completing and submitting this application form you are consenting to have quotations for this class of insurance obtained from various insurance companies that provide this product and who have distribution agreements with United Insurance Group Pty Ltd and Insurance Web Pty Ltd.

 

Quotations are provided to you obligation free. A completed form does NOT BIND the applicant to complete the insurance, nor does insurance commence without first obtaining quotes and a written advice to proceed, however the information in an application form may form part of any insurance contract that should develop from the information provided in this document.

 

Persons completing this application must have the right authority to do so or must have the application reviewed and signed off by those persons with the authority to enter into contractual agreements for and on behalf of the entity named in this application. This quotation facility enables you to lodge a quote request direct to the Insurance Web Customer Service Team with the right information for quick and accurate assessment and thereby provides a superior service in dealing with insurance companies and you as our valued customer. 

 

Simply complete the on-line form and the information will be sent to the appropriate Customer Service team. Following receipt of your request, an email response will be forwarded to you within 2-4 business days.  

 

We are committed to protecting your privacy and confidentiality in accordance with the Privacy Act 1988 (Cth) and it is one our prime concerns that any personal or sensitive information you provide to us is not used for any other purpose than that intended and expected by you. This Privacy Policy overview below, describes our current policies and practices in relation to the handling and use of personal information. You may also see our Privacy policy in our Financial Services Guide (FSG).

 

We will collect personal information for primary purposes, which are relevant to providing and administrating our products and services. We collect the information needed to enable us to provide advice on and arrange financial services. We will usually provide some or all of this information to our product suppliers. Some of these suppliers may be located outside Australia. To enable us to assess any claims made under an insurance policy we and our representatives (including loss adjusters, investigators, medical advisors and lawyers) collect information about the claim, some of which may be personal information. We may collect the information from you or from third parties. We provide this information to the insurer and those appointed to assist you in making a claim. We may use personal information internally to help us improve our services and help resolve any problems.

 

We can only apply for and arrange financial service products if we have all relevant information. The insurance laws also require you to provide us with all the information we need in order to be able to decide whether to insure and on what terms.

 

We hold the information we collect from you in our computer system and in our hard copy files. We ensure that your information is safe by following the usual security procedures expected by our clients.

 

We may disclose information to: 

• Insurers, underwriters, underwriting agencies, wholesale brokers and reinsurers (for the purpose of seeking recovery from them or to assist them to assess insurance risks);

• Premium Funding companies for the purposes of gaining quotations on and arranging funding of your insurance premiums;

• An investigator, assessor, State or Federal Health Authorities, lawyers, accountants, medical practitioners, hospitals or other professional advisors (for the purposes of investigating or assessing your claim);

• A lawyer or recovery agent (for the purpose of defending an action by a third party against you or for the purpose of recovery costs including your excess);

• Contractors who supply services to us, e.g. to handle mailings on our behalf.• An immediate family member;

• Other companies in the event of a corporate sale, merger, reorganisation, dissolution or similar event, however, we will do our best to ensure that they protect the information in the same way that we do. We may provide this information to others if we are required to do so by law or under some unusual other circumstances which the Privacy Act permits. We do not sell, trade, or rent personal information to others.

 

Before you enter into this contract of insurance with an insurer, the Insurance Contracts Act 1984 requires you to tell us and the insurer everything of which you are aware, which you know, or which a reasonable person in the circumstances could be expected to know is relevant to our decision, whether and on what terms your application for insurance is acceptable and to calculate the premium required for your policy. The Act imposes a different duty the first time you enter into the policy with us, from the duty that applies when you renew, vary, extend, reinstate or replace your policy. We set these duties out below. Your duty of disclosure applies when you enter into this policy with us for the first time. You will be asked various questions when you first apply for this policy.

 

When you answer these questions, you must: 

• give us honest and complete answers;

• tell us everything you know;

• tell us everything that a reasonable person in the circumstances could be expected to tell us.

 

It is important that you understand, that you are disclosing to us and answering our questions for both you and anyone else who you want to be covered by the policy.

 

If you do not tell us If you do not answer our questions honestly or do not properly disclose to us, the insurer may reduce or refuse to pay a claim or may cancel the policy. If you act fraudulently in answering our questions or not disclosing to us, the insurer in turn, may refuse to pay a claim or treat the policy as never having existed. This would mean that you were never insured.

 

When you renew, vary, extend or reinstate your policy, your duty is to tell us before the renewal, variation, extension or reinstatement, every matter known to you, which: 

 

• you know; or

• a reasonable person in the circumstances could be expected to know;

• is relevant to an insurance providers decision whether to insure you and, if so, on what terms. 

 

You do not need to tell us about any matter: 

 

• that diminishes the insurance providers risk;

• that is of common knowledge;

• that we know or should know as an insurer; or

• that we tell you we do not need to know.

 

If you make a misrepresentation to us, or if you do not comply with your duty of disclosure and we issue your policy with terms and conditions that are different to the terms and conditions that would have been issued had there not been any misrepresentation, or your duty of disclosure had been complied with, then: 

 

• the insurer may reduce the cover provided, so that we are placed in the same position as they would have been in, had there not been any misrepresentation and your duty of disclosure had been complied with; and

• the insurer may also cancel your policy; or

• the insurer may treat your policy as if it never existed if the misrepresentation or your non-compliance with your duty of disclosure was fraudulent.

 

Please note the Management Liability Cover Section is issued on a CLAIMS MADE basis.

 

This means that this policy responds to: 

 

• claims made against you during the policy period and notified us during that policy period, providing that you were not aware at any time prior to the policy inception of circumstances which would have put a reasonable person in your position on notice that a claim may be made against you; and

 

• pursuant to Section 40 sub-section 3 of the Insurance Contract Act 1984, the policy will also apply to events of which you first became aware during the policy period which could give rise to a future claim, provided that you notify us during that policy period of the circumstances of such events.

 

For full details of cover, please refer to the Product Disclosure Statement and/or Policy wording which sets out the terms and conditions of cover offered. This is available on request and will be sent out with your quotation once prepared.

 

1. Cover section claimed under 

2. Date of Loss 

3. Amount Incurred 

4. Details of the incident 

5. Preventative/Corrective action taken 

6. Claims History Report on Insurance Company Letterhead for each of the past three years

It's not only directors or officers of large public companies who may be exposed to personal liability. If you have a small to medium sized private company, you could be protected by a policy that covers claims from a wide range of management liabilities, such as; 

 

* directors and officers liability

* company reimbursement

* company liability

* employment practice liability

* trustee liability

* statutory liability

* fidelity (theft by employees), and

* business crisis consultant fees 

 

Policy features may also include: Cover for OH&S and pollution defence costs, including representation expenses and the insured persons’ pecuniary penalties (as permitted by law), and extension of cover for company pecuniary penalties (as permitted by law).  

 

WHY CONSIDER THIS COVER: 

For small businesses, the benefits of protection against legal costs involved in defending allegations of unfair dismissal of staff, harassment and bullying in the workplace are a good reason to consider this cover section. Fines and Penalties can also be covered by this section provided that the defence of such a fine is permitted by law and the act causing the fine to be brought was unintentional and not malicious or reckless in nature. OH&S fines are the most common threat to a business for which this cover section incorporates protections against.  

I/we in effecting insurance in accordance with the information provided in this application declare and warrant: 

 

A) The statements in this application form are true and correct; 

B) I/we have disclosed all matters which to my/our knowledge the insurer should be aware of; 

C) That I/we agree to accept that Insurance Web Pty Ltd will use this information in order to source insurance quotations from various insurance providers; 

D) That I/we agree to accept that on receipt of our quotation for insurance cover Insurance Web Pty Ltd shall also provide the relevant Product Disclosure Statement and/or Policy Wording for the insurance cover quoted; 

E) That I/we have access to and have read the relevant Financial Services Guide supplied on the website: www.insuranceweb.com.au and also supplied at time of quoting by email and/or post. 

Signature  

 

 

 

Signed X ...............................................................  

 

 

 

Print name: ________________________________  

 

 

 

Your Title: _____________________________  

 

 

 

Dated: ......../......../..........