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Public Liability Insurance Quote Online Form

 

Please complete the following information and submit this form to obtain an insurance quotation for Public Liability Insurance.

 

Click on one of the following links if you would like the quotation to include other types of cover such as tools or contents, business click here and trades click here.

 

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.

INSURED'S - Details
 

  Name*

 

  Business Address*

 City/Town*

Post Code*

  Postal Address*

 City/Town*

Post Code*

Occupation*

 
Briefly describe the products and/or services your business provides*

Annual Turnover*

  (Total - Annual Business Sales)

No of Staff*

Import/Export?

ABN Number

 

 INSURANCE – Details

 

LIABILITY

Customers Goods

Driving Risk

Do you conduct any welding

Do you employ sub / contractors
  if "Yes", please confirm annual payments to sub / contractors
Do you use labour hire?
  if "Yes", please confirm annual payments to Hired Labour
Do you perform work at airports, railway, oilrigs, gas rigs, oil refineries, chemical refineries, mines or quarries, ship yards?
Do you perform work with/on cooling towers, alarm systems or mainframe computers?
 

 PREVIOUS INSURANCE - Details - MUST COMPLETE ALL QUESTIONS
 
Is the has the property been Insured?*

  If "YES", Please provide the date your existing policy expirers* / /
  Please provide the name of the Insurer*  
   

  Have you ever suffered any losses or claims?

  Have you ever had any insurance cancelled or declined or special terms imposed?

 

  Have you ever been charged or convicted of any criminal offence or declared bankrupt?

 

  Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?

 

 

 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 endeavour 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 Public Liability 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.