CGIB Home

 Phone: 1300 764 244

Email address: email us

Send us a message: click here		  

 

 

     home | online quotes | contact us | about us | products & services

 

 

 

Bookkeepers, BAS Agents & Tax Agents - Only


Professional Indemnity Insurance Quote Online Form

 

Please complete the following information and submit this form to obtain an insurance quotation for your business. Click on one of the following links if you would like to obtain a quote for your office insurance, public liability insurance or another type of insurance product.

 

All information you provide must be correct, true, and accurate as incorrect or misleading information may alter our quote and jeopardise cover if you proceed with a policy.

 

Please refer to the CGIB Financial Services Guide, Privacy Statement, General Advice Warning and Duty of Disclosure before completing this form.

CLAIMS MADE POLICY
This proposal is for a 'claims made and notified' policy of insurance, which means that the policy will respond to claims first made against you and reported to the Insurer during the Period of Insurance, specified in the policy schedule. Any circumstances which you become aware of during the period of insurance, which could give rise to a future claim, provided you inform the Insurer in writing of such circumstances, as soon as practical, within period of insurance.

RETROACTIVE LIABILITY
The retroactive date is the date after which any errors or omissions of the Insured are covered. Any errors or omissions made before the retroactive date are excluded by the policy. The retroactive date may be the time that the Insured first purchased a Professional Indemnity or Directors' & Officers' Liability policy. It is important to make sure that the retroactive date is correct. Remember, that the actual event that causes a claim to be made under the policy may have occurred in a prior period of insurance, but is only covered if it is notified to the Insurers in the period of insurance when the Insured first becomes aware of the claim or circumstances. The act, error or omission must arise from work done after the retroactive date shown in the schedule of the policy for the insurance to respond.

 

INSURED'S & BUSINESS - Details
 
Insured Name*  

  Business/Trading Name/s  

  Address*

 City/Town*

Post Code*

  Postal Address*

 City/Town*

Post Code*

No of Staff*

Website
Date business commenced*

ABN Number

 

STATE / TERRITORY BREAKDOWN
 

Enter percentage of activities on fee income by State* (if nil please enter 0)

NSW VIC QLD SA WA TAS NT ACT O/Sea's TOTAL = 100%
 

ACTIVITY DESCRIPTION - Services
  Please list the categories of activities or business and indicate the percentage of your income derived from each category
 
(for example, bookkeeping 90%, accounting/auditing 10%)
 

Activity*

 % Worked *

Activity

 % Worked

Activity

 % Worked

Activity

 % Worked

Activity

 % Worked

Activity

 % Worked

Activity

 % Worked

Activity

 % Worked

Activity

 % Worked
                   Total 100%

State fully the nature of your business*

Business Annual Income - Total* $

 

 INSURANCE – Details
 

Professional Indemnity - Limit of Indemnity Sum Insured

   

Public Liability - Limit of Indemnity Sum Insured

   

Fidelity - Limit of Indemnity Sum Insured

$
   

Contents - Office

$

 

 
   

Contents - Portable, e.g. Laptop, Mobile Phone, etc.

$
   
 

 PREVIOUS INSURANCE - Details
 
Currently Insured?*
if yes, please provide the date it expirers / / ,
if yes, Please provide the Insurance Company Name*
if yes, please confirm the retroactive date (see your policy)*
 
Please answer the following AFTER ENQUIRY of the partners, principals and directors of the insured:

Has any Claim been made, or has any civil liability been alleged in the last tem (10) years against the business or any of

their predecessors in business or any prior practice of any of their present or former Partners, Principals or Directors, or have 

circumstances been notified to insurers that might give rise to a claim?

Are there any circumstances not already notified to Insurers which may give rise to a Claim against any applicant?

 

Has any applicant ever been refused this type of insurance or had similar insurance cancelled, or had an application or renewal

declined, or had special terms imposed?

 

Has any applicant ever been subject to disciplinary proceedings for professional misconduct?

 
In the last 5 years, has any applicant been declared bankrupt?
In the last 5 years, has any applicant been the subject of administration proceedings?
In the last 5 years, has any applicant been convicted of any criminal offence (other than minor traffic convictions)?
Is any applicant connected or associated (financially or otherwise) with any other practice or business?
Has any other practice or business amalgamated or merged or with you, or have you purchased any other practice or business?
Do you have the appropriate qualifications, licence or authorisation required to perform you professional duties?
Does any contract or client represent more than 50% of your annual work or fees?
Are consultants, sub-contractors or agents engaged by you, required to carry their own professional indemnity insurance?
Do you enter into any hold harmless agreements or otherwise waive any legal rights or entitlements which you may have against such consultants, sub-consultants, sub-contractors or agents?
Do you envisage any substantial changes in your activities or are there any major operations contemplated during the next 12 months?
Has any client refused payment or requested a refund of monies paid?

 

 CONTACT – Details
 

First Name*

Surname*

  Phone No  

  Fax No

 

Email Address*

How did you find us*
 
 
 

*Mandatory Fields
 
 

Thanks for completing our online form.

We will endeavor to contact you with your insurance details soon.

Meanwhile, if you require any further assistance please feel free to contact us.

            

                                                                                          

 

We may need to contact you to obtain additional information to assist us in providing you with a Business Insurance Quotation.

Completion of this form does not put an insurance policy/cover in place - you will need to contact us to arrange insurance cover.

All information you provide must be correct, true, and accurate as incorrect or misleading information may alter our quote and jeopardise cover if you proceed with a policy.

We recommend that you read the relevant Product Disclosure Statement when considering an insurance policy.