On-line Industrial Special Plant Insurance


Thankyou for considering our on-line industrial special plant 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 industrial special plant 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.

1. Situation of Depot:
2a. Precise Business Activities:
2b. Wet Hire: %
2c. Dry Hire: %
3a. Current Underwriter:
3b. Due Date:
4. Have You or any of the directors, proprietors or partners of You or Your business ever been:
a. charged with any offence regarding fraud or dishonesty?
Yes No
b. made bankrupt or placed in receivership or under administration?
Yes No
c. convicted of a criminal offence?
Yes No
Insurance History
5. Have You, Your business or any directors, proprietors and partners of Your Business ever had:
a. insurance refused or a proposal for insurance declined?
Yes No
b. special terms or conditions imposed on insurance?
Yes No
c. insurance cancelled?
Yes No
d. renewal of insurance not invited?
Yes No
e. an insurance claim rejected?
Yes No
Section 1 - Damage
6a. Description of Plant (if insufficient space attach schedule)
YearMake/Model Tonnage Reg. No. Serial No. Sum Insured
$ 
$ 
$ 
$ 
$ 
$ 
6b. Interested Parties
7. Are any of Your machines used or expected to be used:
a. on, in or under water?
Yes No
b. underground?
Yes No
c. in demolition?
Yes No
d. in connection with exploration, natural gases or any other hazardous occupation?
Yes No
If you answered Yes to any of the above, please give details:
Section 2 - Hired-in-Plant
8. Is hired-in-plant cover required?
Yes No
Section 3 - Additional Benefits - for Sections 1 & 2 (1 - 6 apply automatically)
9.
1. Damage to Lifted Goods Sum Insured $5,000* Increase to: $
2. Multiple Crane Operation
3. Expediting Costs Sum Insured $10,000 or 20% of Indemnity, lesser applies*
4. Recover Costs Sum Insured $50,000
5. Indemnity to Hirer
6. Appreciation in Value
7. Additional/Deletions of Machines Sum Insured $250,000* - Notify within 60 days (Section 1)
10. Optional Additional Benefits
a. Agreed Value: Items
(valuation) Yes No
b. Owners Protection
Yes No
(applies to wet hire activities)
c. Owners Protection Plus
Yes No
(applies to dry hire activities)
d. Hired-Out Plant Damage Waivers
Yes No
**attach copy of agreement - please see Question 25
Section 4 - Consequential Loss
11. Is consequential loss cover required?
Yes No
Section 5 - Breakdown
12. Is breakdown cover required?
Yes No
Section 6 - Road Risk (third party property damage only)
13a. Limit of indemnity: $20,000,000
13b. Other:
13c. Registered Units:
13d. Conditional Units:
Section 7 - Broadform Liability
14. Limit of Indemnity: $5,000,000 $10,000,000 $20,000,000
15. Hook Liability (Goods in Care, Custody and Control): $100,000 $500,000 $1,000,000
16. No. of Principals:
17. No. of Employees:
18. Yrs in Business:
19. Estimated annual wages for the coming year: $
20. Estimated annual turnover for each business activity for the coming year: $
21. Use of Sub-Contractors?
Yes No
If Yes, Ins sited:
22. Labour Hire? **attach copy of Labour Hire agreement - please see Question 25
Yes No
23. Railways
a. Does the Insured undertake any work activities that involve an exposure to railways?
Yes No
b. Is the Insured involved in any rail line, rail track construction and / or maintenance?
Yes No
c. Is the Insured involved in any rail signal equipment construction and / or maintenance?
Yes No
24. Claims History (5 years):
Section 8 - Required Documents
25. Supporting Documentation
Please email/fax/mail the following documentation in support of your application:
  • Any Additional Section 1 Description of Plant details
  • Copy of the Hired-Out Plant Damage Waiver agreement (if you answered yes to question 10d)
  • Copy of the Labour Hire agreement (if you answered yes to question 23)


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:
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Your email address:
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