Business Quote Request

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Business Quote Request

Business Quote

Our business pack question set covers the following sections, click NEXT and complete the form with as much details as possible.
- Fire & other specified perils
- Business Interruption
- Burglary
- Money
- Glass
- Liability
- Transit
- Electronic Computer Breakdown
- Machinery Breakdown
- General Property
- Tax Audit
- Employee Fraud
- Motor Vehicles

Who This Enquiry Is For
For us to provide the best response to your inquiry please complete the following
- This inquiry is for an existing business with current insurance
- This inquiry is for an existing business without insurance
- This inquiry is for a new business
Contact Details
First Name
Surname
Address
Suburb / City
Postcode
Telephone
Mobile
Fax
Email
Business Details
Name of the business
Describe your business
What is the required start date of the insurance?
Date Format: DD slash MM slash YYYY
Is your business premise address different to your contact address?
- No
- Yes
Business street address
Business suburb / city
Business postcode
Does your business operate from multiple sites?
- No
- Yes
Age of building in years
What is the roof made of?
- Tile
- Steel
What are the walls made of?
- Brickwork
- Concrete
- Steel on steel
- Steel on wood
What are the floors made of?
- Timber
- Concrete
What type of alarm system is installed?
- Monitored
- Local
- None
Fire & other specified perils
Sum Insured
Building $
Stock $
Contents $
Others (please specify)
Description $
Business Interruption
Indemnity Period
- 6 months
- 12 months
Sum Insured
Gross Profit $
Increased Working Cost $
Wages $
Rent $
Other $
Other Description
Total $
Burglary
Sum Insured
Contents $
Stock $
Tobacco $
Combined contents / stock $
Other $
Other Description
Money
Sum Insured
In Transit $
On Premises $
On premises outside $
Business hours $
In Safe $
Personal custody $
Other $
Other Description
Glass
Sum Insured
Internal or External
- Internal - Replacement Value
- External - Replacement Value
Signs $
Liability
Sum Insured
Payout
- $5 Million
- $10 Million
- $20 Million
Turnover $
Wages Paid $
Staff Numbers $
Are you the property owner?
- No
- Yes
Describe tenant's business
Do you import products?
- No
- Yes
Product 1
Country of origin 1
Product 2
Country of origin 2
Country of origin 3
Product 3
Transit
Own Vehicles
Maximum Value per load $
Annualised Total Carry $
Number of Vehicles #
Professional Carriers
Maximum Value per load $
Annualised Total Carry $
Electronic Computer Breakdown
Describe equipment you wish to insure
Sum Insured $
Machinery Breakdown
Sum Insured
Refrigerator
Amount of units
Units $
Air Conditioner
Amount of units
Units $
Other
Amount of units
Units $
General Property
Describe equipment you wish to insure 'away from your business' (e.g. laptop computers)
Sum Insured
Tax Audit
Sum Insured $
Employee Fraud
Sum Insured $
Motor Vehicles
Make and model
Year
Registration Number
Main Driver
Date Of Birth
Date Format: DD slash MM slash YYYY
The vehicle is garaged
- No
- Yes
Garage postcode
NCB rating or rating number
Use
- Business
- Private
Under Finance
- No
- Yes
Final Questions
Prior to the Insurer accepting any risk they will require information about any claims over the past 5 years where the claims relate to the type of insurances you wish to take out. Please describe those claims:
Email a copy to me
- Tick for yes
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Email
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