On-line Business Insurance


Thank you for considering our on-line commercial / business insurance service.   Because Greater National Group is an insurance broker, not an insurance company, we will process your application with major insurance companies in order to find the right commercial / business insurance for you.

Please fill in the following form as fully as possible, then click 'submit' at the end of the form.
You can use the TAB key to move to the next field. We will respond with your terms as soon as we have researched the market for the right available deals that fit your requirements.


1a. Business Name:
1b. Situation of risk (address, including postcode please):
Business details:
1c. Trade / business type:
1d. Number of staff:
1e. Annual salary / wages paid: $ 
1f. Sales / Turnover / Gross Rentals per annum: $ 
1g. Building occupied by (please select from list):
1h. Period occupied by proposer:  years
1i. Period in this type of business:  years
Fire insurance details:
2a. Age of building:  years
2b. Height:  m
2c. Approx. area:  sq m
2d. Condition of building (please describe):
3. Fire Protection:
Single sprinklers   Dual sprinklers   Hydrants/hoses   Fire blankets
Number Of Extinguishers
4a. Vats (deep frying):
Yes No
4b. Capacity:  Litres
4c. Thermostatically Controlled:
Yes No
Details about the premises' construction:
5. Walls:
Bricks/Concrete   Iron   Timber   Fibro  Other 
6. Roof:
Iron   Tiles  Other 
7. Floors:
Concrete   Timber  Other 
8. Windows:
Single Front   Double Front   Multi  Describe 
Burglary insurance details:
Details about anti-theft protection you currently have:
9. Alarm:
Monitored   Local   No alarm
10. Connection:
Landline   Securitel   Dialler
11. Sensors:
Infra Red   Window detector / tapes
12. Deadlocks:
All doors  Other 
13. Other:
Patrols   24 hour security guard
Claims & Insurance Experience:
14. Please detail briefly any insurance claims in the last five years:
15. Have you ever had any insurance cancelled or declined or special terms imposed?:
Yes No
16. Have you ever been charged or convicted of any criminal offence or declared bankrupt?:
Yes No
Insurance Amounts:
Please enter the value you wish to be insured up to in each area relevant to you:
17. Fire and Accidental Damage
17a. Building: $ 
17b. Stock: $ 
17c. Other contents: $ 
17d. Removal of debris: $ 
17e. Loss of rent: $ 
17f. Rewriting of records: $ 
18. Business interruption
18a. Insurable gross profit: $ 
18b. Additional increased cost of working: $ 
18c. Claims preparation costs: $ 
19. Burglary
19a. Stock: $ 
19b. Tobacco / Cigarettes: $ 
19c. All other contents: $ 
19d. Specified items: $ 
20. Money
20a. In transit: $ 
20b. Business Hours: $ 
20c. Outside Business Hours: $ 
20d. Locked safe: $ 
20e. Residence: $ 
20f. Safes / storerooms: $ 
21. Glass
21a. External:
 21b. Internal:
21c. Signs: $ 
22. Liability
22a. Public: $ 
22b. Products: $ 
23. General property
23a. General property: $ 
24. Computers
24a. Hardware: $ 
24b. Data Media: $ 
24c. Inc costs: $ 
25. Machinery
25a. Unspecified: $ 
25b. Specified items: $ 
25c. Do any boilers or pressure vessels require certification?
Yes No
25d. Food spoilage: $ 
26. Goods in transit
26a. Goods in transit: $ 


Duty of Disclosure:
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?
Yes No
If so, please provide details:
I/We hereby declare that:
My/Our attention has been drawn to the Important Notices accompanying this form and further I/we have read these notices carefully and acknowledge my/our understanding of their content. The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter between the date of this form and the inception date of the insurance to which this relates I/we shall give immediate notice thereof. I/We authorise GNG and the Insurer to collect or disclose any personal information about another individual (for example, an employee, or client), I/we declare that the individual has been or will be made aware of that fact and the Privacy Policy. I/We also confirm that I/we am/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this form and I/we complete this form on their behalf.
Any other comments, requests or relevant information you need to add:
Contacting you about your quote:
In order to select the most appropriate cover for you, it may be important to discuss quote details in person. Please leave a contact phone number and best time to call to facilitate this.
Your full name:
Company/Business/Name of Applicant to be Insured:
ABN:
Your phone number (please include area code):
Your mobile phone number:
Best time(s) to call:
Please send my quote by (select at least one):
email phone fax mail
Your email address:
Your website address:
Your fax number:
Your postal address:
Country: