Quote


Business Name:

Contact Name*:

Contact Number*:

Email Address*:

Business Address Suburb:

Business Address Postcode:

State*:

Please select your required Sum Insured:
 $5,000,000 $10,000,000 $20,000,000

Please confirm the number of On-Tool Proprietors / Directors:
 1 2

Please confirm the number of On-Tool Employees:
 1 2 3 4 5

Please confirm the number of Sub-Contractors:
 1 2 3 4 5?

Does your business provide any other services in addition to Painting & Decorating?
 YES NO

In the past 5 years, have you made any claims under a previous Public Liability policy?
 YES NO

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Business Name:

Contact Name*:

Contact Number*:

Email Address*:

Business Address Suburb:

Business Address Postcode:

State*:

Please select the Total value of General Property / Tools of Trade to be insured:
 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000

In the past 5 Years, have you made any General Property / Tools of Trade claims?
 YES NO

Do you have any individual General Property items / Tools of Trade valued over $2,000?
 YES NO

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Business Name:

Contact Name*:

Contact Number*:

Email Address*:

Business Address Suburb:

Business Address Postcode:

State*:

Please select the type of cover required:
 Personal Accident ONLY Personal Accident & Sickness?

Please confirm your current age:

Please confirm your date of birth:

Please confirm your Weekly Benefit Sum Insured:
?

Do you provide any other services in addition to Painting & Decorating?
 YES NO

Are there any Pre-Existing medical conditions or injuries to disclose?
 YES NO

Are you currently insured for Personal Accident and / or Illness insurance?
 YES NO

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Business Name:

Contact Name*:

Contact Number*:

Email Address*:

Business Address Suburb:

Business Address Postcode:

State*:

How many vehicles do you require cover for:
 1 2 3 4 5

Vehicle 1

Registration #:

Cover Type:
 Comprehensive Third Party Property Damage Only

Use:
 Business Private

Vehicle 2

Registration #:

Cover Type:
 Comprehensive Third Party Property Damage Only

Use:
 Business Private

Vehicle 3

Registration #:

Cover Type:
 Comprehensive Third Party Property Damage Only

Use:
 Business Private

Vehicle 4

Registration #:

Cover Type:
 Comprehensive Third Party Property Damage Only

Use:
 Business Private

Vehicle 5

Registration #:

Cover Type:
 Comprehensive Third Party Property Damage Only

Use:
 Business Private

In the past 5 Years, have you made any Motor Vehicle claims?
 YES NO

In the past 5 Years, have any regular drivers had any driving and / or criminal convictions?
 YES NO

In the past 5 Years, have any regular drivers had their license suspended or cancelled?
 YES NO

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Business Name:

Contact Name*:

Contact Number*:

Email Address*:

Business Address Suburb:

Business Address Postcode:

State*:

Home Warranty  YES NO

Property

Fire & Defined Events  YES NO

Burglary  YES NO

Business Interruption  YES NO

Portable Valuable Items  YES NO

Glass  YES NO

Money  YES NO

Machinery Breakdown  YES NO

Electronic Equipment Breakdown  YES NO

Goods In Transit  YES NO

Legal Liability

Public Liability  YES NO

Product Liability  YES NO

Product Recall  YES NO

Professional Indemnity  YES NO

Directors & Officers  YES NO

Statutory Liability  YES NO

Other Commercial Insurance

Commercial Motor  YES NO

Contract Works  YES NO

Tax Audit  YES NO

Employee Crime  YES NO

Trade Credit (Debtors)  YES NO

Corporate Travel  YES NO

Group Personal Accident & Illness  YES NO

Cyber Crime  YES NO

Domestic Insurance

Home & Contents  YES NO

Private Motor  YES NO

Landlords  YES NO

Personal Accident & Illness  YES NO

Marine Pleasure Craft  YES NO

Leisure Travel  YES NO

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Group Personal Accident and Sickness Insurance Product
Disclosure Statement and Policy Wording

Austbrokers Business Insurance – Business Special Risks Policy Wording

Austbrokers Liability Insurance 2009

General Property wording – Master Painters

Loan contract

Zurich Motor Insurance Product Disclosure Statement

Public Liability Claim Form

General Property Claim Form

Motor Vehicle Claim Form

MGA
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