INSURED'S - Details

  Business Name*

  Business Address*

 City/Town*

Post Code*

  Postal Address

 City/Town*

Post Code *

Occupation*

Please Select Antenna Installer Asphalt Contractor Blind / Curtain Installer Bread Vendor - Delivery Bricklayer Builder - New Homes & Renovations Builder - Home Restumping and Underpinning Builder - Commercial Built in Wardrobe and Shower Screen Installation Cabinet Maker Car Detailer Carpenter Carpet Cleaning Carpet Layer Cartage Contractor Cleaner - Domestic Cleaning Services - Domestic & Commercial Concrete Sawing Concretor Drainage / Sewerage Contractor Electrician Fencing Contractor Floor Polisher / Sander Garage Door Installation Gardener - No Tree Lopping Gardener - Including Tree Lopping Glazier Handyman - Household Repairs Landscape Gardener Lawn Mowing Contractor Locksmith Mechanic - Mobile Metal Shed Erector Milk Delivery Mobile Hairdresser Mobile Home Food Catering Painter, Decorator Paving Contractor - No Public Areas Paving Contractor - Public Areas Pet Washing Pergola, Patio, Carport Erector Plasterer and Ceiling Contractor Plumber Pool Maintenance & Cleaning Roofer or Roof Tiler Saw Doctor Shop Fitter Sign Writer - Excluding Spraying Sign Writer - Inc Spraying Site Preparation Services Skylight Installer Tiler - Floor Tiler - Roof TV Cable Installation Window Cleaner - Up To 3 Levels Window Cleaner - Inc over 3 Levels

Occupation - Other

Annual Turnover *

No of Staff*

 INSURANCE – Details

PORTABLE ITEMS Tools, Laptops, etc

TAX INVESTIGATION

Not Required $10,000 $20,000 $30,000 $40,000 $50,000

LIABILITY

Not Required $5,000,000 $10,000,000 $20,000,000

Customers Goods

Do you conduct any welding

No Yes

 PREVIOUS INSURANCE - Details

  Have you ever suffered any losses or claims

No Yes

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

No Yes  

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

No Yes  

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

No Yes  

 CONTACT – Details

First Name*

Surname *

  Phone No

   (please include area code)

  Fax No

   (please include area code)

Email Address*

How did you find us?*
---Please Select--- American Vehicle Sales Better Buying Group Building Commission Building Industry Solutions Building Inspector Conveyancer Fair Trading Dept NSW Friend or Family Member Google Search Government Department Im a Existing CGIB Client Insurance Broker Insurance Company Internet Search Steadfast White Pages www.ownerbuilder.net.au Yellow Pages Book Yellow Pages Online Other if other, please provide details

 * 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 provide you with an 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.