Welcome | Haisey Insurance

Product Selection

Select the policies that you need to protect your business. Once you have your quotes you will be able to change your cover levels and select the polices that you need.

Cover generally taken by others in your industry to protect the essential risks of doing business. Professional Indemnity Public liability

Additional cover regularly selected by others in your industry to give them a higher level of protection for their business. Personal accident insurance Management liability

Your business

Please enter the full address of your physical business premise (a P.O. Box is not acceptable).

Inception Date *

Expiry Date

What level of professional indemnity cover do you require?

What level of public liability cover do you require ?

As at today's date does the insured have professional indemnity insurance currently in force that has been paid for? * Yes No

Additional Services

Please specify your Revenue by business activity:

The Provision of disabled or aged care services (Total sum must be 100%)

Do you perform any medical treatments or procedures that are required to be undertaken by a qualified medical practitioner ? * Yes No

Are you appropriately qualified and/or have you completed the appropriate training to perform the activity ? * Yes No

In the last 10 years, have any claims for a breach of professional duty been made against the business, its predecessors in business or its current or former partners/principals/ directors or employees? * Yes No

After enquiry, are you aware of any circumstances which may result in a claim against the business or any its partners, Principals, Directors or employees ?* Yes No

In the last 10 Years, has your business or you or any partner or director Yes No

» Had any business insurance/liability claims?

» Had any insurance declined or cancelled ?

» Been Convicted of any criminal offence?

» Been Liable for any civil offence or pecuniary penalties?

» Suffered any loss or damaged which would have been covered by the proposed insurance policy?

» Been declared bankrupt or involved in a business which became insolvent?

Type of Payment * Invoice Direct Debit

Title

Name

Position

I have read and agree to the Duty of Disclosure.

Disability Or Aged care Services

Disability Or Aged care Services

Your Information

Product Selection

Regularly Selection

Your business

Your Professional indemnity Cover

Additional Services

Your history

Payment Details

Acknowledgement of terms of business

Head Office

Contact Us

Email