Public Liability and Professional Indemnity

Your Information

Your business

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

Street Address
Suburb
Postcode
 
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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.

  Professional Indemnity   Public liability

Your Professional indemnity Cover

  Yes No

Additional Services

Please specify your Revenue by business activity (Example ISP, Web Hosting or Application Services etc):

% Add New
Total Sum must be 100% 0%
  Yes No
  Yes No

Your Professional liability Cover

  Yes No
  Yes No

Your history

  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?

Payment Details

  Invoice Direct Debit

Acknowledgement of terms of business


Your Duty of Disclosure

In accordance with the provisions of the Insurance Contracts Act 1984 (Section 22), we are required to advise you of your responsibilities in relation to the disclosure of relevant information.

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 Insurers every matter that you know, or could reasonably expect to know, is relevant to the Insurer’s decision whether to accept the risk of insurance 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 disclose of matters:
a) that diminishes the risk to be undertaken by the Insurer;
b) that is common knowledge;
c) that your Insurer knows or, in the ordinary course of business, ought to know;
d) as to which the compliance with our 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 the 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.

Declaration

I declare that the contents of this form are true and that I have not omitted any material information. If this information differs before the contract of insurance is concluded, I will tell the Insurers.

  I have read and agree to the Duty of Disclosure.