Your duty, however, does not require disclosure of matter:

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2 Your Duty of Disclosure Before you enter into contrct of generl insurnce with n insurer, you hve duty, under the Insurnce Contrcts Act 1984 (Cth), to disclose to the insurer every mtter tht you know, or could resonly e expected to know, is relevnt to the insurer s decision whether to ccept the risk of the insurnce nd, if so, on wht terms. You hve the sme duty to disclose those mtters to the insurer efore you renew, extend, vry or reinstte contrct of generl insurnce. Your duty, however, does not require disclosure of mtter: Tht diminishes the risk to e undertken y the insurer; Tht is of common knowledge; Tht your insurer knows or, in the ordinry course of its usiness, ought to know; As to which complince with your duty is wived y the insurer. Non Disclosure If you fil to comply with your duty of disclosure, the insurer my e entitled to reduce their liility under the contrct in respect of clim or my cncel the contrct. If your non-disclosure is frudulent, the insurer my lso hve the option of voiding the contrct from its eginning. Privcy Policy We re ound y the Privcy Act 1988 (Cth) or s mended nd its ssocited Ntionl Privcy Principles when we collect nd hndle your personl informtion. We collect personl informtion in order to provide our services nd products. We lso pss it to third prties involved in this process such s our reinsurers, gents, loss djusters nd other service providers. If you do not provide the informtion we need we my not e le to offer you insurnce or del with clim(s) under your insurnce. You cn seek ccess to nd if necessry, correct your personl informtion y contcting our Privcy Officer. When you give us personl or sensitive informtion out other individuls, we rely on you to hve mde or mke them wre tht you will or my provide their informtion to us, the purposes we use it for, the types of third prties tht we disclose it to nd how they cn ccess it. If it is sensitive informtion we rely on you to hve otined their consent on these mtters. If you hve not done either of these things, you must tell us efore you provide the relevnt informtion. Our Privcy Officer my e contcted during usiness hours on: Telephone: Fx: Mil: Locked Bg 18, Royl Exchnge, NSW, 15 Lierty Interntionl Underwriters is trding nme of Lierty Mutul Insurnce Compny ABN , incorported in Msschusetts, USA. The liility of memers is limited.

3 1 The Insured Full nme of ech proposed Insured including susidiries who will e conducting usiness relted ctivities*: Compny Nme ABN 1 3 Full description of opertions nd ctivities of ech proposed Insured*: 1 3 Principl Street Address 3 *Plese ttch dditionl pges if insufficient spce. Period of Insurnce / / t 4pm Locl Stndrd Time / / t 4pm Locl Stndrd Time 3 Limit of Indemnity Pulic nd Products Liility: $5 million $10 million $0 million Any one occurrence in respect of Pulic Liility nd in the ggregte during the Period of Insurnce in respect of Product Liility. Asestos Removl Liility: $5million $10million Any one Clim nd in the ggregte during the Period of Insurnce Note: If Asestos Removl Liility cover required plese lso complete Questions 1 4 of the Asestos Removl Liility Questionnire. 4 Estimted Pyroll Estimted Annul Pyroll (including ernings of Principls, Directors, Prtners) tl Pyroll $ Lierty Interntionl Underwriters is trding nme of Lierty Mutul Insurnce Compny ABN , incorported in Msschusetts, USA. The liility of memers is limited.

4 Pyment to contrctors nd/or sucontrctors (other thn lour hire) $ Pyments to lour hire personnel/compnies $ Do you hire out ny of your employees to third prties on lour hire sis? Yes No If Yes, plese dvise: Estimted nnul revenue: Activities undertken: 4 5 Estimted Annul Turnover Plese indicte estimted nnul turnover/nnul gross income for the following ctegories: Demolition $ Erthmoving nd Excvtion $ Slvge nd Slvge Sles $ Asestos removl $ Shoring nd Underpinning $ Other detils $ tl $ (If pplicle, ttch product rochures, nnul reports, wesite or other mteril) Wesite: www. 6 Complince With Stndrds With regrd to demolition nd welding work, do you perform your opertions in ccordnce with the following current Austrlin Stndrds: AS601 The Demolition of Structures Yes No AS1675 Sfety in Welding nd Allied Processes? Yes No 7 Cre, Custody nd Control Do you hve the property of others in your cre, custody or control? Yes No Plese note tht coverge is limited to $50,000 in the ggregte for ny one period of insurnce. Lierty Interntionl Underwriters is trding nme of Lierty Mutul Insurnce Compny ABN , incorported in Msschusetts, USA. The liility of memers is limited.

5 8 Clims nd/or Loss Experience Hve you hd ny insured nd/or uninsured clims in the lst 5 yers? Yes If Yes, plese provide detils elow: No Dtes Clims reported Amount pid & outstnding Applicle excess Description 5 After investigtion, re you wre of ny circumstnces which could give rise to clim under the proposed Policy nd which re not mentioned ove? Yes No If Yes, plese provide detils: c Hve you hd ny insured nd/or uninsured sttutory fines nd penlties in the lst 5 yers? Yes No If Yes, plese provide detils: Dte of Fine Amount Offence 9 Previous Insurnce History After investigtion hve you ever hd ny: c d e f Insurnce declined or cncelled? Yes No Hve you hd ny Sttutory Fines nd Penlties Yes No over the pst 5 yers? Renewl refused? Yes No Specil conditions imposed? Yes No Incresed excess imposed? Yes No Clims denied for this clss of insurnce? Yes No Lierty Interntionl Underwriters is trding nme of Lierty Mutul Insurnce Compny ABN , incorported in Msschusetts, USA. The liility of memers is limited.

6 Only complete these questions if Asestos Liility is required. Otherwise continue to Declrtion. Importnt Notice Asestos Liility Clims Mde Insurnce This is proposl for Clims Mde policy of insurnce. This mens tht the Asestos Liility Endorsement to this Policy covers you for ny clims mde ginst you nd notified to the insurer during the policy period. The policy does not provide cover in reltion to: cts, errors or omissions tht occurred prior to the retroctive dte (if one is specified) in the policy; ny clim mde, thretened or intimted ginst you prior to the commencement of the policy period; ny clim or fct tht might give rise to clim, reported or which cn e reported to n insurer under ny insurnce policy entered into efore the commencement of the policy period; ny clim or fct tht might give rise to clim, noted in this proposl or ny previous proposl; ny clim rising out of ny fct you re wre of efore the commencement of the policy period; ny clim mde ginst you fter the expiry of the policy period. However, the effect of Section 40(3) of the Insurnce Contrcts Act 1984 (Cth) is tht where you ecome wre, nd notify us in writing s soon s is resonly prcticle fter first ecoming wre ut within the policy period, of ny fcts which might give rise to clim ginst you, ny clim which does rise out of such fcts shll e deemed to hve een mde during the policy period, notwithstnding tht the clim ws mde ginst you fter the expiry of the policy period. 6 1 Generl In wht yer did you commence removing sestos? Do you ensure your employees nd su-contrctors fully comply with ll stte regultions nd/or codes of prctice for working with sestos nd mn-mde minerl fires? Yes No Note: Indemnity is suject to government mndtory stndrds eing dhered to y the Insured. Turnover & Wges Estimted turnover nd wges for sestos-relted work Turnover Wges Actul for prior 1 months $ $ Estimte for next 1 months $ $ Note: This declrtion is suject to udit. Lierty Interntionl Underwriters is trding nme of Lierty Mutul Insurnce Compny ABN , incorported in Msschusetts, USA. The liility of memers is limited.

7 3 Current Asestos Liility Insurnce Do you currently hve sestos liility insurnce? Yes No If No, plese proceed to the next question. If Yes, is coverge Clims Mde? Yes No If No, plese proceed to Question 4. If Yes, 1 Wht retroctive coverge dte ppers on your policy? Wht limit of indemnity do you currently hve? 7 4 Clims nd/or Loss Experience Hve you hd ny insured nd/or uninsured clims in the lst 5 yers? Yes If Yes, plese provide detils elow: No Dtes Clims reported Amount pid & outstnding Applicle excess Description After investigtion, re you wre of ny circumstnces which could give rise to clim under the proposed Policy nd which re not mentioned ove? Yes No If Yes, plese provide detils: Lierty Interntionl Underwriters is trding nme of Lierty Mutul Insurnce Compny ABN , incorported in Msschusetts, USA. The liility of memers is limited.

8 Declrtion I, (print nme in full) (Title/Position) I declre tht to the est of my knowledge nd elief the nswers given ove or documents sumitted represent the true position nd tht I hve not withheld ny mteril informtion from this proposl. I gree tht this proposl nd ny ccompnying documents shll form or prtly form the sis of the Contrct Proposed. Signture: 8 Dte: Plese complete the ove questionnire nd return to Mrk McNmr t Tudor Insurnce Austrli Pty Ltd on: Emil: Phone: Fx: Lierty Interntionl Underwriters is trding nme of Lierty Mutul Insurnce Compny ABN , incorported in Msschusetts, USA. The liility of memers is limited.

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