CGU Padlock. insurance application
|
|
- Laureen Webb
- 8 years ago
- Views:
Transcription
1 CGU Padlock insurance application
2 CGU Insurance Limited ABN Please read the following information before you complete the application. Keep this information for your records. Please read and keep the policy booklet for this insurance. Extract from the Insurance Contracts Act 1984 Under the terms of the Act We must advise You about the following: Your duty of disclosure Before you enter into a contract of general insurance with an insurer, you have a duty, under the Insurance Contracts Act 1984, to disclose to the insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer s decision to accept the insurance risk and, if so, on what terms. You have the same duty to disclose those matters to the insurer before you renew, extend, vary or reinstate a contract of general insurance. Your duty however does not require disclosure of a matter that diminishes the risk to be undertaken by the insurer; that is of common knowledge; that your insurer knows or, in the ordinary course of its business, ought to already know; as to which compliance with your duty is waived by the insurer. Non-Disclosure If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce its liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning. Important Information 1. Delay of Cover We will not provide any cover, for a period of 48 hours from the time of the commencement of your insurance, for Damage or loss caused by: (a) bushfire or grassfire; or (b) a named cyclone. This Exclusion does not apply, however, if this insurance commences directly after another insurance policy covering the same property expired, without a break in cover, 2. Acceptance of the Application This insurance will not be in force until the completed Application has been received by Us and the risk accepted by Us. We reserve the right to decline any Application. 3. Alterations to Your Business To ensure continued cover under this Policy it is important that You advise Us immediately of any changes to Your Business, that may result in an increased chance of destruction, loss or damage to property insured or liability to third parties. Some examples of changes about which You should notify Us are: (a) changes in Your name or directors or partners; (b) changes to the address or location of your Business; (c) changes in the nature of your Business or trade or occupation: (d) alterations in construction of the premises; When We receive notification of a change We may decide to either: 1. adjust the premium or terms of the Policy, or 2. cancel the Policy in accordance with the provisions of the Insurance Contracts Act Workers Compensation The insurances provided by this Policy do not include Workers Compensation. It is compulsory for all employees to be insured for Workers Compensation and separate cover should be arranged. 5. Underinsurance/Average If you choose a sum insured that is lower than it would actually cost to replace an item this is called Underinsurance. If this happens you may be required to bear a portion of the loss yourself. 6. Date Recognition Special Exclusion (Year 2000) This policy is subject to a Date Recognition Special Exclusion, refer to policy wording. 7. The way we handle your Personal Information We collect personal information from you for the purpose of providing you with insurance products, services, processing and assessing claims. You can choose not to provide this information, however, we may not be able to process your requests. We may disclose information we hold about you to other insurers, an insurance reference service or as required by law. In the event of a claim, we may disclose information to and/or collect additional information about you from investigators or legal advisors. If you wish to update or access the information we hold about you, contact us. 8. Excess Excess or deductible is the sum of money we will not pay in respect of a claim. The Policy and the Schedule detail the deductibles which may be applicable. When complete, please forward this application to: CGU Insurance, GPO Box 9902 in the capital city of your state or your insurance adviser or your local CGU Insurance office.
3 CGU Insurance Limited ABN CGU Padlock Insurance Application CGU Insurance use only Policy no. 0 : 1 : R : : : : : : : : LOB ISR This Application replaces cover note number UW Code: NN992 Please answer all questions. This will help us to process your application quickly. If you need more space to answer any of the questions, please use a separate sheet of paper. Any attachments will form part of this application and the declaration will include them. General Questionnaire Note: If more than one person is applying for insurance, these questions must be answered in respect of each individual person. Please tick ( ) Yes or No and give details as requested. Yes No 1. Has any insurer declined an application from You, or cancelled or refused to renew a policy of Yours, required special terms to insure You, or declined or refused a claim? 2. Have you sustained any loss or damage to property, whether or not you made an insurance claim, or had any claims made against You in the last 5 years? 3. Have You, or any person who will receive insurance protection under the proposed policy, been charged with, or convicted of, any criminal offences in the past 10 years? 4. During the last 2 years have You or any other person to whom cover extends under this policy received any threats to life or property (private or business)? 5. Are there any other relevant facts relating to the risk to be insured which You should disclose to Us, to enable a true assessment of Your insurance application? 6. Is any portion of the property to be insured in a state of disrepair or poor condition? If You have answered Yes to any of questions 1-6 above please give full details. (If insufficient space, please use separate paper). Question no. Reasons Intermediary Name Account no. Insured Details Insured Name ABN/ACN Telephone Facsimile Policy start date (dd/mm/yy) Policy End Date (dd/mm/yy) Interested Parties: Name of interested party Address of interested party Type of interest (e.g. Mortgagee) Postcode Name of interested party Address of interested party Type of interest (e.g. Mortgagee) Postcode Occupation Please list all tenants business occupation. If insufficient space use notes page.
4 Claims History/Current Underwriter List details of all claims in the last 3 years. Situation of Risk Sit. Address Post Code Occupied as Construction Details of Property to be Insured (complete for each situation in order as above) Construction: C = Concrete B = Brick F = Fibro I = Iron O = Other Sit. Walls Frame Roof Floors Age Stories Floor Area Security & Risk Management (complete for each situation in order as above) Sit. Smoke Detectors Hose Reels Sprinklers Extinguishers Fire alarms Declared Values Section 1 Property (complete for each situation in order as above) Sit. Buildings Contents Specified Items Total Declared Values Section 2 Loss of Income (complete for each situation in order as above) Sit. Annual Rent Other Income Indemnity Period Total Has any property to be insured previously been flooded? Yes No Is the property serviced by a town water supply? Yes No
5 Is the property professionally managed? Yes No Is the situation serviced by an operational fire brigade? Yes No Is the property under a heritage or national trust or other protection order? Yes No Section 1 Property Building and Contents Total Sum Insured (the total of all buildings and contents listed on page 4) Specified Items Total Sum Insured (the total of all specified items listed on page 4) Total Sum Insured Specified Items (list all items and sum insured separately) Section 2 Loss of Income 1. Annual Rent 2. Other Income 3. Total Annual Income 4. Indemnity Period Months 5. Total of Annual Income (X) Indemnity Period 12 months X (1) 18 months X (1.5) 24 months X (2) 36 months X (3) 6. Additional Increased Cost of Working 7. Accountants Fees (if more than 5,000 cover required) Total Sum Insured (the sum of 5, 6 and 7) Section 3A Theft Building and Contents Total Sum Insured (the total of all buildings and contents listed above) Specified Items Total Sum Insured Total Theft Sum Insured Specified Items (list all items and sum insured separately)
6 Section 3A Money In Transit/Bank/NightSafe/ ATM 50,000 On Premises (Business Hours) 50,000 In Locked Safe/Strongroom 50,000 In Private Residence 5,000 On Premises (Outside Bus. Hours not in Locked safe) 5,000 Section 3C Rent Default Rent Default (maximum 26 weeks cover) Annual Rent Excess 1st 4 weeks rent Section 4 Glass Internal and External Glass Sum Insured Replacement Value Are you (the Property Owner) responsible for insuring the building glass? Yes No Section 5 Taxation Audit Total Sum Insured 5,000 Excess nil Do you require a higher sum insured? If yes, insert sum insured required Has the Australian Taxation office served a general notification to your industry that it will be carrying out audits of your industry? Yes No Section 6 Legal Costs OH&S Breach Total Sum Insured 100,000 Excess nil Section 7 Liability Limit of Indemnity Excess 500 Property Damage claims only Annual Turnover Section 8 Machinery Is Blanket Machinery cover required? Yes No If No, specify sum insured required here and detail items of machinery together with new replacement value per item below Is Air Conditioning plant utilizing centrifugal compressors or other air conditioning plant which has a rated cooling capacity greater than 20 kw? Yes No If yes, please specify items below and advise new replacement value of air conditioning plant Specified Machinery
7 (a) Is machinery and plant regularly serviced? (b) Is any machinery or plant item more than 20 years old, or not in current production? (c) Has any machinery or plan item been modified to perform other than originally intended by the manufacturer? If yes, Please provide details of the modifications Standard Excess - Sections 1, 2, 3A, 3B and 4 A Standard Excess will be applied for each and every claim for Section 1 - Property, 2 - Loss of Income, 3A - Theft, 3B - Money and 4 - Glass cover. Unless otherwise agreed, the following Standard Excess will apply for these Sections. Total Sum Insured Sections 1 & 2 Combined Up to 2,500,000 From 2,500,000 to 5,000,000 From 5,000,000 and above Excess ,00 or 0.01% of total sum insured Do you wish to vary the Standard Excess Yes No If yes, please specify the excess required For all other Sections the excess will be specified within the particular section. Duty of Disclosure In answering our questions, you must be honest, and tell us anything that you or a reasonable person in the circumstances would include in your answers. It is important that you understand you are answering the questions for yourself and anyone else to whom the questions apply. We may be entitled to reduce our liability under the contract, or cancel the policy, or refuse to pay a claim by anyone insured, if you have not answered our questions in this way. Do you understand and accept your duty of disclosure? Yes No Has any insurer declined an application for You, or cancelled or refused to renew a policy of Yours, required special terms to insure You, or declined or refused a claim? Yes No Declaration To be completed by each person applying for insurance I/We declare that: a) the particulars and statements in this Application are true, correct and complete, and contain all information known to me/us. b) I/we agree to accept the insurance subject to the terms, conditions, exclusions and limitations of the Policy. c) I/we have received the Important Notices under the Insurance Contracts Act I/We authorise CGU Insurance Limited to obtain or supply details of insurance claims and other relevant information. Signature of Applicant Date Signature of Applicant Date / / / / Please indicate the number of additional pages attached to this application Premium Calculations Premium FSL GST Stamp Duty Total
8 Application Guidelines General Underinsurance/Average - When Your Sum Insured is less than 80% of the full amount You should insure for, You may not receive full compensation in the event of a loss. Average puts You in a position where You proportionately share the loss. Underinsurance/Average applies to Property, Loss of Income and Rent Default. Section 1: Property Under this Section You have a Sum Insured for Buildings and Contents and Specified Items (if Specified Items are insured). When establishing your Sums Insured they should represent the amount it would cost to replace the property insured in its entirety. So that you are not disadvantaged by the Underinsurance/Average clause, you should specifically indicate any property that you do not wish to insure. Accidental Damage The amount payable for any loss for which a claim would be payable under the Property Section for Accidental Damage is limited to the Sum Insured you have taken for Section 1 - Property. Section 2: Business Interruption Under this Section You can insure Gross Rent and other Income incidental to Your Business. Uninsured working expenses should be those expenses that will reduce in direct proportion to a reduction in income. The indemnity period should be the period You consider it would take to restore the income of Your business to the same position it was on the day the loss occurred. This should be calculated as the amount of time it would take to rebuild your property. If Your indemnity period exceeds 12 months Your Sum Insured should be increased proportionately. Section 3A: Theft of Property Your Sum Insured is set at 100% of the cover you select for Section 1 Property. If you have artworks or curios in excess of 50,000, these should be specified in your application. Section 3B: Money Your cover includes the following cover types: Money in Transit, Money on Premises during Business Hours, Money in Securely Locked Safe or Strongroom, Money on Premises outside Business Hours and Money in Private Residence. Separate limits apply to each of these cover types and you should ensure that these meet your requirements. Section 4: Glass Specified Glass - is for insuring glass other than internal or external glass such as signs and a Sum Insured is required for these items. Section 5: Taxation Investigation Covers the costs incurred by Your Accountant or Registered Tax Agent (after receiving notification from the Australian Taxation Office) in conducting taxation audits or detailed investigations in relation to Your liability to pay income tax, fringe benefits tax, capital gains tax or sales tax, A New Tax System (Goods and Services Tax), superannuation payments tax, termination payments tax, but does not include the amount of such tax and fines or penalties. Section 6: Costs for Occupational Health & Safety breaches This section covers any reasonable legal costs and expenses incurred in appealing against the imposition of a fine; a prohibition notice; or a determination by any court or tribunal under any workplace, occupational heath and safety, or similar legislation. Section 7: Liability You should ensure that the Limit of Indemnity You select is adequate. Your Limit of Indemnity should be sufficient to cover court awards made against You some years after the Personal Injury or Damage to Property happens. For Products Liability the Limit of Indemnity must be sufficient to cover all claims happening during any one Period of Insurance. Section 8: Machinery You can insure for Blanket Cover or Specified items. Blanket Cover will insure all your Machinery, Electronic Equipment and Pressure Equipment. Certain items of Air conditioning plant are excluded. These are known as air conditioning plant utilizing centrifugal compressors or any other air conditioning plant which has a rated cooling capacity greater than 20 kw and you must specify these items if you want cover. The Sum Insured should be sufficient to include removal, transport, repair and replacement of the machine and the cost of delivery to the site of any parts required. The amount payable in respect of a breakdown will not exceed the market value of the machine at the time of loss. CID0193 REV0 11/08
Business Insurance Proposal
Business Insurance Proposal Important Notices You must read the notices below. If you have any questions please contact GWS Genco Group (AFSL No. 231210) Duty of Disclosure This Policy is subject to the
More informationCOMMERCIAL BUSINESS INSURANCE QUESTIONNAIRE
COMMERCIAL BUSINESS INSURANCE QUESTIONNAIRE Current Broker Policy. Current Insurer Expiry Date Contact Name Postal Address Phone Fax Mobile Website Email Insured Full names of Insured Persons or Companies
More informationCommercial Retail Industrial Insurance Application
QBE INSURANCE (AUSTRALIA) LIMITED ABN 78 003 191 035 Commercial Retail Industrial Insurance Application Policy. Client. Intermediary. The Applicant/s Name of Insured in full (Block Letters) Surname(s)
More informationfirst choice home insurance application first choice home
first choice home insurance application first choice home CGU Insurance Limited ABN 27 004 478 371. An IAG Company. Please read the following information before you complete the application. Keep this
More informationBusiness Insurance Property Owners
Business Insurance Property Owners Insurance Application & Proposal Intermediary Interim Cover No. The Proposer Insured Name Business/Trading Name Are you registered for GST purposes? Yes No What is your
More informationliability insurance application liability Insurer CGU Insurance Limited ABN 27 004 478 371 An IAG Company
liability insurance application liability Insurer CGU Insurance Limited ABN 27 004 478 371 An IAG Company Extract from the Insurance Contracts Act 1984 Under the terms of the Act We must advise You about
More informationBusiness Insurance Application
Business Insurance Application Office Use Only Core Customer Segment: Account Number: Policy Number: Important Notices Duty of Disclosure Before you enter into a contract of insurance with Ansvar Insurance
More informationcommercial / business proposal
commercial / business proposal Important Notice (Please read before completing this Proposal) you, your where used in this Proposal means the Proposer and if more than one, each of them. we, us, our means
More informationCommercial-Retail-Industrial Insurance Application
QBE INSURANCE (AUSTRALIA) LIMITED ABN 78 003 191 035 Commercial-Retail-Industrial Insurance Application Policy No. Client No. Intermediary No. THE APPLICANT/S Name(s) in full Tax Status Registered Business
More informationBusiness Insurance Property Owners - Vacant
Business Insurance Property Owners - Vacant Insurance Application & Proposal Intermediary Policy The Proposer Insured Name Business/Trading Name Are You registered for GST purposes? What is Your ABN Postal
More informationCommercial Insurance Application
Commercial Insurance Application IMPORTANT Commercial NOTICE RELATING Insurance TO THIS APPLICATION Application Please read this section before you complete the Application. IMPORTANT NOTICE RELATING Commercial
More informationSTRATA PROPOSAL & QUOTE FORM RESIDENTIAL & COMMERCIAL IMPORTANT NOTICES. This is an important document. Please read it carefully.
STRATA PROPOSAL & QUOTE FORM RESIDENTIAL & COMMERCIAL IMPORTANT NOTICES This is an important document. Please read it carefully. The information you provide in this document and through any other documentation,
More informationAction Insurance Brokers Pty Ltd Public Liability Insurance Proposal
Action Insurance Brokers Pty Ltd Public Liability Insurance Proposal Period of Insurance to Day Month Year Day Month Year at 4.00pm Name of Insured (inc. all subsidiary companies) Postal Address Description
More informationmotor vehicle insurance application for privately owned non-commercial vehicles (excluding motorcycles) motor vehicle
motor vehicle insurance application for privately owned non-commercial vehicles (excluding motorcycles) motor vehicle CGU Insurance Limited ABN 27 004 478 371. An IAG Company. Please read the following
More informationLandlords Insurance. Application
Landlords Insurance Application Landlords Insurance Application Form Important Information Product Disclosure Statement This application is for Australian Unity Landlords Insurance. Please read the product
More informationNTAA Office Pack Insurance
NTAA Office Pack Insurance Questionnaire Insured Details Insured Name: Trading Name: Business Address: ABN: Contact Person: Phone: Interested Parties: State: Business website: Email: Mobile: Postcode:
More informationGeneral Liability Insurance GROUP PTY LTD. Proposal Form. RSM GROUP Pty Ltd - Wholesale Broking
GROUP PTY LTD General Liability Insurance Proposal Form RSM GROUP Pty Ltd - Wholesale Broking ABN 40 006 361 226 AFS Licence No. 239631 380-382 Canterbury Road, Surrey Hills Vic 3127 Private Bag 4000 Surrey
More informationmayhave occurred during the period of insurance; Avoid the contract from its beginning, if your non-disclosure fraudulent
Arena Underwriting Pty Ltd ABN: 26 125 869 481 AFSL: 317617 Suite 8, 12 Alma Road, New Lambn NSW 2305 Tel: 02 4952 4477 Fax: 02 4915 5376 www.arenaunderwriting.com.au PUBLIC & PRODUCTS VOLUNTARY LIABILITY
More informationCHILDCARE PROPERTY OWNERS INSURANCE APPLICATION FORM
CHILDCARE PROPERTY OWNERS INSURANCE APPLICATION FORM Public & Products Liability and Professional Indemnity Insurance and Property Insurance. IMPORTANT NOTICE: PLEASE READ & RETAIN IN YOUR FILE This is
More informationCoversure Security Industry Insurance Proposal
Intermediary Date / / Contact Name Phone ( ) Period of Insurance to at 4.00pm INSURED DETAILS Insured Name / ABN (Full details required, inc. Trading Name if Applicable) Postal Address Location of Premises
More informationProfessional Indemnity Insurance Proposal.
ProJuris Professional Indemnity Professional Indemnity Insurance Proposal. Important information What is a proposal? This proposal tells us information, which we need to know in order to decide whether
More informationBajaj Allianz General Insurance Company Limited
Bajaj Allianz General Insurance Company Limited Regd. Office & Head Office : GE Plaza, Airport Road, Yerwada, Pune - 411 006 P - 4092-1. Name of Proposer SHOPKEEPERS INSURANCE POLICY Proposal Form Important
More informationProfessional Indemnity Insurance Application Form Marsh Accountants Insurance Program
Professional Indemnity Insurance Application Form Marsh Accountants Insurance Program Phone: 1300 093 634 Email: accountants@marsh.com tice to the Applicant This notice must be read before you complete
More informationsp rts Sports Coaching & Clinics Insurance Application Form Underwriting Australia Sports Leisure Licensed Clubs
sp rts Underwriting Australia Insurance Application Form Sports Leisure Licensed Clubs Please use this application for occupations relating to the including: Sports Clinics Sports Coaches School Sports
More informationProfessional Indemnity Proposal Form
Professional Indemnity Proposal Form IMPORTANT NOTES This insurance cover is based upon representations given to us by you. Should any particulars have changed or be incorrect you must notify us immediately.
More informationAustralian Institute of Professional Photography photographic insurance application form
Australian Institute of Professional Photography Please Return the Completed Application to: Marsh Pty Ltd Consumer Professional Photographers Insurance GPO Box 1229, Melbourne Vic 3001 Telephone: 1300
More informationCalliden Construction Work and Legal Liability
Calliden Construction Work and Legal Liability Insurance Proposal Important tices You must read the tices below. If you have any questions please contact your insurance adviser direct or our office. Visit
More informationHow To Get Insurance For A Car
Veterinarians Professional indemnity insurance (including optional public and products liability insurance and employment practices liability insurance) Proposal form 2011-2012 Please return completed
More informationMOTOR VEHICLE PROPOSAL FORM
Commercial and Trucksure Pty Ltd As agent for the Insurer ABN: 78 078 661 220 AFSL: 238151 Level 6, 3 Spring Street Sydney NSW 2000 PO Box R1940 Royal Exchange NSW 1225 Telephone: (02) 9251 1155 Facsimile:
More informationProfessional Indemnity Insurance and optional Public & Products Liability
Advantedge Members (Incorporating PLAN, FAST and CHOICE Members) Professional Indemnity Insurance and optional Public & Products Liability Proposal form 2014-2015 Please return completed proposal form
More informationEntertainment & Event Liability Insurance Proposal
Intermediary Date / / Contact Name Phone ( ) Period of Insurance to at 4.00pm INSURED DETAILS Insured Name / ABN (Full details required, inc. Trading Name if Applicable) ABN: Address / Situation Description
More informationMotor Equity Insurance. Policy Document (Product Disclosure Statement) 216469 POL373 Alph cov_d1.indd 2 6/03/13 12:47 PM
Motor Equity Insurance Policy Document (Product Disclosure Statement) 216469 POL373 Alph cov_d1.indd 2 6/03/13 12:47 PM Preparation Date: 01/03/2013. 216469 POL373 Alph cov_d1.indd 3 6/03/13 12:47 PM Table
More informationProfessional Indemnity Proposal Form
Professional Indemnity Proposal Form BuildSafe Insurance Brokers Pty Ltd ABN 84 109 623 976 AFSL 279367 5 Peninsula Boulevard, Seaford, Vic. 3198 Postal: P. O. Box 2294 Seaford, Vic. 3198 Phone: 1300 763
More informationProfessional Trainers, Licensing Assessment and Consultancy Services Professional Indemnity and Public Liability Insurance Proposal Form
Tranznet Association Inc Arranges the insurance IMPORTANT INFORMATION Professional Trainers, Licensing Assessment and Consultancy Services Professional Indemnity and Public Liability Insurance Proposal
More informationPROPOSAL FORM. Fleet Heavy Motor Vehicle Insurance. Page 1 of 7. Important Notices Please read these Important Notices before completing the Proposal.
PROPOSAL FORM Fleet Heavy Motor Vehicle Insurance Important Notices Please read these Important Notices before completing the Proposal. Duty of Disclosure Under the Insurance Contracts Act 1984 (the Act),
More informationIMPORTANT INFORMATION
IMPORTANT INFORMATION Please read these notices before completing the Proposal. Policy This Policy is an important document and should be kept in a safe place. Please read it carefully so that you understand
More informationConsultants Insurance Application
Consultants Insurance Application Notice to the proposed insured: It is a requirement of the insurance Contracts Act 1984 and the Corporations Act 2001 that the following notices 1., 2., 3., 4., 5. and
More informationProfessional Trainers, Licensing Assessment and Consultancy Services Professional Indemnity and Public Liability Insurance Proposal Form
Tranznet Association Inc Arranges the insurance IMPORTANT INFORMATION Professional Trainers, Licensing Assessment and Consultancy Services Professional Indemnity and Public Liability Insurance Proposal
More informationhome insurance home claim report
home insurance home claim report CGU Insurance Limited ABN 27 004 478 371. An IAG Company. Please retain this page for your information About your claim Most policies allow for replacement of property
More informationHome Insurance. Claim Report
Home Insurance Claim Report CGU Insurance Limited ABN 27 004 478 371 AFSL 238291 Please retain this page for your information About your claim Most policies allow for replacement of property with the nearest
More informationIMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM
IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM Your Professional Indemnity Insurance Policy is issued on a CLAIMS MADE basis. This means that this policy
More informationHow To Get Insurance On A Company Policy In Australia
Proposal Form: Directors and Officers Insurance Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM. Your Directors & Officers Insurance
More informationMARSH BIZSECURE INSURANCE PROPOSAL FORM
MARSH BIZSECURE INSURANCE PROPOSAL FORM Name of Company : PARTICULARS OF PROPOSER Correspondence Address : Telephone Number : Website : Fax Number : Description of Business/Trade : Period of Insurance
More informationProfessional Indemnity Insurance Proposal Form for Actuaries (short form)
Professional Indemnity Insurance Proposal Form for Actuaries (short form) Marsh Pty Ltd ABN 86 004 651 512 Darling Park Tower 3 201 Sussex Street SYDNEY NSW 2000 PO Box H176 AUSTRALIA SQUARE NSW 1215 Telephone
More informationProfessional indemnity insurance and optional public liability insurance
Agricultural Consultants Professional indemnity insurance and optional public liability insurance Proposal form 2011-2012 Please return completed proposal form to: Aon Risk Services Australia Limited ABN
More informationProduct Disclosure Statement
MTA Insurance Limited Equity Plus Insurance Product Disclosure Statement This document must be read in conjunction with the Application/Certificate of Insurance for MTA Equity Plus Insurance. Together
More information4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director
SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au ACCOUNTANTS PROFESSIONAL INDEMNITY
More informationJUA Underwriting Agency Pty Ltd
JUA Underwriting Agency Pty Ltd Valuers Professional Indemnity Proposal Form Please answer every question fully, incomplete answers will not be accepted, and may result in a delay in terms being issued
More informationClaims Made Policy (applies to Professional Indemnity only) Your Duty of Disclosure. Excess. Your Legal Liability. Waiver of Rights.
Proposal Form Professional Indemnity & Public Liability Insurance for Swimming Pool Inspectors Arranged through ASR Underwriting Agencies Pty Ltd Underwritten by Certain Underwriters at Lloyd s IMPORTANT
More informationCOMMERCIAL PACKAGE POLICY - PROPOSAL FORM
IMD Code : Bajaj Allianz General Insurance Company Limited IMD Name : Sub IMD Code : COMMERCIAL PACKAGE POLICY - PROPOSAL FORM Important: This proposal for insurance will be the basis of any subsequent
More informationACCOUNTANTS, BOOKKEEPERS & RELATED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
ACCOUNTANTS, BOOKKEEPERS & RELATED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant
More informationBoat Insurance Renewal
boat insurance application CGU Marine Insurance A Division of CGU Insurance Limited ABN 27 004 478 371 Please read the following information carefully. Tear off this page and keep for your reference. Your
More informationHOME BASED BUSINESS PROPERTY INSURANCE APPLICATION FORM
HOME BASED BUSINESS PROPERTY INSURANCE APPLICATION FORM IMPORTANT NOTICE: PLEASE READ & RETAIN IN YOUR FILE This is a generic form, not all of the above policies may be included in your current coverage
More informationBusiness Insurance Proposal Form
Intermediary: Brokers Name: Phone Number: Intermediary Address: Email Address: 2. Insured Company Name: Name of Insured: Situation Address: ABN Number: ITC : Interested Parties: 3. Period of Insurance
More informationProperty Claim Report
Property Claim Report This form is to be used for reporting a claim for lost, stolen or damaged property, including: Accidental damage Illegal use of credit card Accidental loss Impact Burglary Lightning
More informationChurch Insurance. Proposal Form
Church Insurance Proposal Form Church Insurance Proposal Form To complete this form: Print form Use black pen to fill in details Attach additional page(s) if insufficient space Please send completed Church
More informationWill you be claiming any Input Tax Credits on the GST applicable to this policy? Yes No If Yes, what percentage? % Suburb State Postcode
Accountants Professional Indemnity Insurance. Proposal Form Please complete and return this proposal form to Aon Risk Services Australia Ltd, GPO Box 1230, Melbourne VIC 3001 If you have any questions,
More informationProfessional Indemnity Insurance
QBE Insurance (Australia) Limited ABN 78 003 191 035 Professional Indemnity Insurance Application Form Pool Safety Inspectors Notice to the Applicant This notice must be read before you complete the Application
More informationPublic and Products Liability insurance proposal.
Public and Products Liability insurance proposal. Liability Intermediaries Important notices. Policy Number Please read this section before completing this proposal Your Duty of Disclosure: You have a
More informationPROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant information for your adviser to submit on your
More informationIMPORTANT NOTICES: Your duty, however, does not require disclosure of matter:
IMPORTANT NOTICES: CLAIMS MADE POLICY This Proposal is for a policy issued by ProRisk on a claims made and notified basis. This means that the policy only covers claims first made against you during the
More informationProfessional Indemnity API VALUERS PROPOSAL FORM
Professional Indemnity API VALUERS PROPOSAL FORM Please return this completed proposal to: Perrymans General Insurance Brokers PO Box 596, Kent Town SA 5071 Fax: 08 8362 3131 Email: api@perrymans.com If
More informationPublic & Products Liability Proposal Form IMPORTANT NOTES
Public & Products Liability Proposal Form IMPORTANT NOTES Completing this Proposal Form does not mean that you will automatically be granted insurance cover proposed. However, if insurance is granted,
More informationPROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM Answer all questions. Blanks &/or dashes, or answers known to underwriters or brokers or N/A are not acceptable & will delay consideration of this proposal.
More informationYour. Product Disclosure Statement and Insurance Policy
Your Product Disclosure Statement and Insurance Policy In arranging this insurance Defence Bank Limited ABN 57 087 651 385 AFSL /Australian Credit Licence 234582 is acting pursuant to an agreement with
More informationJUA Underwriting Agency Pty Ltd
JUA Underwriting Agency Pty Ltd Engineers & Architects Professional Indemnity Proposal Form Please answer every question fully, incomplete answers will not be accepted, and may result in a delay in terms
More informationProfessional Indemnity Proposal form
Important Information Please read this first Professional Indemnity Proposal form Important facts relating to this proposal form You should read the following advice before proceeding to complete this
More informationspecified contract works and legal liability proposal
W000001 specified contract works and legal liability proposal for building construction contracts Important Notices relating to this Proposal You should read the following comments and the Declaration
More informationProfessional Indemnity Proposal Form. for. Accountants. Address: 5/3352 Pacific Highway Postal: PO Box 976. Springwood QLD 4127 Springwood QLD 4127
Professional Indemnity Proposal Form for Accountants Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200 Email: pidirect@pidirect.com.au
More informationMEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM
MEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM IMPORTANT INFORMATION Please read the following information before completing this proposal A. Your Duty of Disclosure Before you enter
More informationREAL ESTATE AGENTS & PROPERTY MANAGERS PROFESSIONAL INDEMNITY PROPOSAL FORM
IMPORTANT NOTICES CLAIMS-MADE INSURANCE REAL ESTATE AGENTS & PROPERTY MANAGERS PROFESSIONAL INDEMNITY PROPOSAL FORM This policy is issued on a claims-made basis. This means that the policy only covers
More informationAAMT Massage Therapist Proposal Form Combined Malpractice, Public and Products Liability Insurance effective 30 September 2015
Page 1 of 5 AAMT Proposal Form Combined Malpractice, Public and Products Liability Insurance effective 30 September 2015 Please complete and return this proposal form via post, email or fax using the contact
More informationPROFESSIONAL INDEMNITY INSURANCE PROPOSAL
NOTICE TO INSURED (Pursuant to the provisions of the Insurance Contracts Act 1984) Your Duty of Disclosure Before you enter into a contract of general insurance with an insurer, you have a duty, under
More informationLandlords Residential Property Insurance Claim Report
Landlords Residential Property Insurance Claim Report CGU Insurance Limited ABN 27 004 478 371 Please retain this page for your information About your claim We will contact you as quickly as possible about
More informationProposal Form: Management Liability Insurance
Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM. Your Management Liability Insurance Policy is issued on a CLAIMS MADE basis.
More informationProposal form Zurich Business Insurance
Proposal form Zurich Business Insurance Important information Please read the following before completing this proposal. ZU07418 - PCUS-000093-2006 Privacy Zurich respects your privacy. Before we collect
More informationLiability Package for Associations and Non-profit Organisations
Liability Package for Associations and n-profit Organisations Answer all questions. Blanks or dashes, or answers known to underwriters or brokers or N/A are unacceptable & will delay consideration of this
More informationProposal Form. Architects Professional Indemnity
Proposal Form Architects Professional Indemnity Important Notices Please read these notices before completing the Proposal Form. Your Duty of Disclosure Before you enter into a contract of general insurance
More informationBLOCK OF FLATS PROPOSAL FORM SUMMARY OF COVER
BLOCK OF FLATS PROPOSAL FORM SUMMARY OF COVER Insurance Corporation s Block of Flats insurance is a modern, convenient policy giving wide cover at a competitive price. It has been designed to meet the
More information1. NAME OF FIRM TO BE INSURED 2. ADDRESS OF FIRM 3. THE FIRM. (please include full names of all entities to be insured) Phone ( ) Email
SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au MISCELLANEOUS PROFESSIONAL INDEMNITY
More informationLABOUR FORCE PROFESSIONAL LIABILITY INSURANCE PROPOSAL FORM
SURA LABOUR HIRE PTY LTD SUITE 1.04 29 31 LEXINGTON DRIVE BELLA VISTA NSW 2153 TELEPHONE. 02 9672 6088 SURA.COM.AU LABOUR FORCE PROFESSIONAL LIABILITY INSURANCE PROPOSAL FORM IMPORTANT NOTICES The information
More informationMiramar Broadform Liability Insurance Proposal
Miramar Broadform Liability Insurance Proposal IMPORTANT NOTES YOUR DUTY OF DISCLOSURE Before You enter into a contract of general insurance with an insurer, You have a duty, under the Insurance Contracts
More informationProfessional Indemnity Insurance Proposal Form for Engineers and Construction Professionals
Professional Indemnity Insurance Proposal Form for Engineers and Construction Professionals Answer all questions. Blanks &/or dashes, or answers known to underwriters or brokers or N/A are not acceptable
More informationPersonal Accident & Illness Application Form
Personal Accident & Illness Application Form Personal Accident & Illness Application Form Important Notice to the Proposer for completion of this proposal form 1. Disclosure Any 'material fact' must be
More informationProduct Disclosure Statement
MTA Insurance Limited Marine Equity Insurance Product Disclosure Statement This document must be read in conjunction with the Application/Certificate of Insurance for MTA Marine Equity Insurance. Together
More informationNew Business Proposal Static
MEDICAL MALPRACTICE COMBINED LIABILITY AND PROPERTY INSURANCE STATIC FOR BEAUTY THERAPISTS Important Notice: This is for a Medical Malpractice Combined Liability Policy issued on a claims made and notified
More informationCouriers insurance package form
Page 1 of 5 Couriers insurance package form Important Information Duty of Disclosure Before you enter into a contract of insurance, you have a duty under the Insurance Contracts Act 1984 (Cth) to disclose
More informationFact Finder - Business Pack
1st Floor, 50 Hindmarsh Square Adelaide SA 5000 PO Box 6095 Halifax St Adelaide 5000 Phone 08 8413 6300 Facsimile 08 82119838 enquiries@brecknock.com.au brecknock.com.au Fact Finder - Business Pack Advice
More informationShip Repairers Combined Liability Insurance Proposal
Ship Repairers Combined Liability Insurance Proposal 1 Proposer Full name of proposer (incl company and trading name): 2. Proposers postal and physical address: 3 Period & Limit of Liability Cover requested
More informationAUCTIONEERS & VALUERS ASSOCIATION OF AUSTRALIA
Professional Indemnity Insurance Proposal Form AUCTIONEERS & VALUERS ASSOCIATION OF AUSTRALIA IMPORTANT NOTICE Your Duty of Disclosure Before you enter into a contact of general insurance with any insurer,
More informationProfessional Indemnity MISCELLANEOUS PROPOSAL
Professional Indemnity MISCELLANEOUS PROPOSAL Please complete, sign and return with all attachments to: Name Position Address Email Phone If you have any questions regarding this form, please do not hesitate
More informationFind Me A Trainer Insurance Offer
Find Me A Trainer Insurance Offer Get Covered. Whether you are just starting out or have been in the industry for years, you will need Public Liability and Professional Indemnity insurance that protects
More informationProfessional Indemnity Insurance for the Planning Profession
Professional Indemnity Insurance for the Planning Profession Important Notices Claims Made Policy This Proposal is for a policy issued by the insurer on a claims made and notified basis. This means that
More informationBERKLEY INSURANCE AUSTRALIA IMPORTANT NOTICES: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL
Fleet Motor Insurance Proposal BERKLEY INSURANCE AUSTRALIA IMPORTANT NOTICES: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into a contract
More informationPublic Relations / Marketing Consultants. Professional Indemnity Insurance
Public Relations / Marketing Consultants Public Relations Consultants Marketing Consultants Market Research Consultants Advertising Consultants Graphic Designers Professional Indemnity Insurance Proposal
More informationProfessional Indemnity Proposal Form. for. Financial Planners
Professional Indemnity Proposal Form for Financial Planners Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200 Email: pidirect@pidirect.com.au
More informationCOMMERCIAL COMBINED PROPOSAL FORM
COMMERCIAL COMBINED PROPOSAL FORM Incorporating Manufacturing Light Industrial High Risk Property Heavy Industrial Please answer all the following questions for each of the relevant sections as fully as
More information4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director
SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au FINANCIAL PLANNERS PROFESSIONAL INDEMNITY
More informationCOMMERCIAL / BUSINESS MOTOR VEHICLE FLEET INSURANCE QUESTIONNAIRE
COMMERCIAL / BUSINESS MOTOR VEHICLE FLEET INSURANCE QUESTIONNAIRE Current Broker Claim Bonus / Rating Entitlement Current Insurer Expiry Date Contact Name Postal Address Phone Fax Mobile Website Email
More informationBUSINESS, EXECUTIVE, LIFE COACHES PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
BUSINESS, EXECUTIVE, LIFE COACHES PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant information
More information