Business Insurance - Australia Wide. SME and Public Liability Cover - Insurance Brokers Sydney Melbourne Brisbane Adelaide Perth Hobart - Market Stall Insurance

Business Insurance

AUSTRALIAN & NEW ZEALAND NATIONWIDE INSURANCE SERVICES
Sydney • Brisbane • Melbourne • Adelaide • Perth • Wellington • Auckland

TV Satellite & Installer Insurance

NEEDS ANALYSIS FORM

For insurance of a Motor Vehicle &/or Trailer used in your
business, an option will appear on the completion of this Form

Terms and Conditions

BUSINESS DETAILS -

Section 1

Please tell us about your business activities

Have you or anyone associated with your business ever made a claim under this type of insurance?		Yes No

Details of Claims and Amounts Paid

Suburb where your Business is located

State

Postcode

If you require cover for more than the limitations above please contact us

What is the Expiry Date of your current insurance - or What date would you like a Quote from?		DD / MM / YYYY

PUBLIC LIABILITY INSURANCE ONLY -

Section 2

Public Liability:-

YOU MUST SELECT THE LEVEL OF COVER YOU REQUIRE
ie; $5 million or $10 million or $20 million

No. of Employees:-

YOU MUST SELECT THE NUMBER OF EMPLOYEES WHO WORK FOR YOU EVEN IF YOU ARE A SOLE TRADER YOU MUST SELECT "SOLE TRADER"

IF PUBLIC LIABILITY IS ALL YOU REQUIRE PLEASE

TO TAKE YOU TO 'SECTION 4

TOOLS OF TRADE - MATERIAL LOSS AND DAMAGE -

Section 3

You do not need to complete this section if all you want is Public Liability Insurance -

Usually, Tools of Trade means:- the tools of trade, related machinery and devices that you ordinarily use in the conduct of your trade.

However, in many cases Tools of Trade will not include, unless specified:-

	Contents and Stock of a business premises which include furniture & fittings, general office equipment including computers and hardware accessories, cash registers, phones and facsimiles and internal walls, windows, cash and trading stock;
	your personal property;

Please tell us the type of Tools of Trade you want to insure, i.e. Power Tools, Fixed Machinery etc.

Not sure please contact me

If any single item of your Tools of Trade have a value of more than $2,500 you need to tell us. Please describe the property and values in this box. Not sure please contact me

INSURED VALUES

Considering the information above please select the amount you would like to insure your Tools of Trade for:-

Important:- Determining an insured value is never easy but it is extremely important - you could use the same amount you are currently insured for however, you need to take into consideration the value of any new and/or updated property that may increase the overall value of your Tools of Trade. It may be necessary to arrange a valuation and we can help you with that or it may be the case that your accountant will be able to tell you the value from current accounting records.

INSURED PERILS

Tick the Perils that you require Cover for - we recommend that you take cover for all the Insured Perils:-

Storm and Tempest
Malicious Damage
Burglary, Theft, Larceny
Fire

Do you require cover for any additional Insure Perils?

TOOLS OF TRADE SECURITY

Kept in Locked Premises O/Night

Yes No

In Locked Vehicle O/Night

Yes No

PREMIUM INSTALMENT REQUEST -

Section 4

Do you require Premium Instalment options?

Yes No

[i.e. monthly or quarterly payments]


DISCLOSURE AND ACKLOWLEDGEMENT DETAILS -	Section 5

Please examine your Duty of Disclosure

Have you or any person associated with this activity ever:-

had a Legal Liability claim made upon you or the other person?

ever made a claim for insurance in respect of the type of cover you require?

been refused insurance?

had an insurance claim of any type refused or reduced?

been charged with a crime of any type?

Is there anything else you
need to disclose to us?

If yes, please write here what it
is that you think we ought to know

I acknowledge I have read and I agree to the terms and conditions stated. (Tick box)

Your Answer is Mandatory

YOUR INFORMATION -

Section 6

First name
Last name
Business name
Address of where your Business is situated [Include Postcode and State]
Postal address if different from above [Include Postcode and State]
Business Telephone [Include Area Code]
Facsimile [Include Area Code]
Mobile
Email Address
Do you have any other comments/requirements?

RGIB is an Insurance Broker, we work for you so the more information you give us helps us to arrange a better insurance deal for you. We will not use your information for any other purpose or provide it to anyone else.

Are you Currently Insured? Yes No

Which company?

Other

It is helpful to know who your current insurer is so we do not approach that insurer again

If you just want the Cheapest and Best Deal click here

Thank you we will do our best to respond in the next few hours - but we may need to contact you for further information

Rural & General Insurance Broking P/L [RGIB] is an Australian licensed Insurance Brokerage [AFSL 262-353]