We Love Tradies Trade Proposal

1. Your Details
First Name*
Last Name*
Phone
Mobile*
Email*
Date of Birth*

DayMonthYear
Street Address*
State*
City*
Postcode*
2. Business Details
Business Description*
Estimated Turnover for the next Financial Year
Estimated Payroll for the next Financial Year
Number of Proprietors / Partners / Principals giving advice
Number of Manual Workers (Directors / Employees / Labour Only Sub Contractors / Work Experience)
Number of Bona-fide Sub-contractors: (Subcontractors that supply both Labour and Materials)
Non Manual (clerical) Workers (Directors / Employees / Labour Only Sub Contractors / Work Experience)
Number of Temporary Manual Workers:
Average days worked (temporary manual workers):
Experience of Proprietors/Partners/Directors/Principals exceeds 1 year?
Claims in the last 5 years?*

YesNo
If yes, please provide details of claim
3. Coverage Details
Do you require Public/Products Liability Insurance?*

YesNo
Limit of Indemnity
Do you require Professional Indemnity Insurance?*

YesNo
Limit of Indemnity
Please advise if a separate fee is charged for Advice Only?*

YesNo
If Yes, please advise total annual fees for advice.
Do you require Tools of Trade Insurance?*

YesNo
Please advise limit required
Claims in the last 3 years?*

NoYes
If yes, please provide details of claim
Proposed Start Date

MonthDayYear
4.00pm Local Standard Time at the Insured’s address
4. Excess Level
Liability
Professional Indemnity
Tools of Trade
5. General Details

Have You or any director or partner involved with the Business or any other business have in the past 5 years:
1. Ever been declared bankrupt or insolvent.*

YesNo
2. Ever been convicted of or charged (but not yet tried) or been given an Official Police Caution in respect of any criminal offence other than a motoring offence.*

YesNo
3. Ever had any previous insurer decline a proposal, refuse to renew a policy or impose special terms or conditions.*

YesNo
4. Ever been convicted of any offence relating to the Health and Safety of your employees or members of the public in connection with your business*

YesNo
6. Claims History

In connection with The Business or any other business in which You or any director or partner are, or have been involved, and in respect of the cover(s) now granted:
1. There have been losses/claims made for the risks No proposed exceeding $1,000 in the last 5 years.*

YesNo
If Yes, please provide full details
2. There have been losses/claims made for two losses of the same type or 2 losses of any type in the last 5 years whether insured or not.*

YesNo
If Yes, please provide full details
7. Acknowledgements
Duty of Disclosure Notice

Before you enter into an insurance contract, you have a duty to tell the insurer anything that you know, or could reasonably be expected to know, may affect their decision to insure you and on what terms.

You have this duty until they agree to insure you.

You have the same duty before you renew, extend, vary or reinstate an insurance contract.

You do not need to tell the insurer anything that:
   - reduces the risk they insure you for; or
   - is common knowledge; or
   - they know or should know as an insurer; or
   - they waive your duty to tell them about.

If you do not tell the insurer something
If you do not tell the insurer something you are required to, they may cancel your contract or reduce the amount they will pay you if you make a claim, or both.

If your failure to tell them is fraudulent, they may refuse to pay a claim and treat the contract as if it never existed.
I have read, understand and agree to the above Duty of Disclosure notice
Yes
I have read, understand and agree to the Financial Services Guide*
A copy of this can be found at http://www.amsinsurance.com.au/downloads/AMS_FSG.pdf
Yes
I have read, understand and agree to the Privacy Policy. A copy of this can be found at http://www.pscconnect.com.au/privacy/
Yes
Signature*

Clear
Should be Empty:

1. Your Details

2. Business Details

3. Coverage Details

4. Excess Level

5. General Details

6. Claims History

7. Acknowledgements