!-- saved from url=(0022)http://internet.e-mail --> Office Quote - Australian Insurance Brokers

On-line Office Insurance


Thank you for considering our on-line office 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 office 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. Describe Your Business activities in full:
2. What is the annual turnover of the Business: $
3. How many years have You been in: this Business? any similar business?
4a. Interested Parties in Your Building(s) and/or Contents:
4b. Nature of their interest: Mortgage Lessor Bill of Sale Other
5. Interested Parties' addresses:
6. Have You or any person applying for this insurance:
a. been convicted of or had any fines or penalties imposed for any criminal offense?
Yes No
b. ever been placed in bankruptcy, receivorship or liquidation?
Yes No
If You have answered Yes to either part of this question, please provide full details:
7. Have You ever had insurance refused or cancelled or had any insurance company ever imposed special terms, conditions or restrictions on Your policies?
Yes No
If Yes please provide full details:
8. Have You claimed under an insurance policy or had any uninsured losses in respect of the proposed covers?
Yes No
If Yes please provide all insurance claims made in the last 5 years and any uninsured losses:
Date Insurer Amount Paid Excess Details Of Loss
$ $
$ $
$ $
$ $
$ $
Premises
9. Situation of Premises:
10 Building construction Modern office block* Brick/Massive** Other
* Modern office block - less than 25 years of age, at least 2 storeys, fire rated floors, internal load-bearing walls (lift/services/fire stair shafts etc), columns and roof, external walls of glass and/or building panels
** Brick/Massive - fire rated floors, internal and/or external load-bearing walls and columns, light weight construction roof.
11. How are the Premises protected against fire and theft?
a. Connected to town water and in the area of a permenantly staffed Fire Service?
Yes No
b. Fire sprinkler system?
Yes No
c. Is there any foam panel construction?
Yes No
If yes, what is the percentage: %
d. Does this risk comply with current Fire and Council Regulations?
Yes No
e. Indicate Building security measures?
Deadlocks all external doors
Keylock/Bars on accesible windows
Local Alarm
Monitored Alarm
f. Are Your Premises contained wholly within a shopping complex (without external access)?
Yes No
Material Damage
12. Do You require this section
Yes No
13. Buildling Sums Insured
a. Building including landlord's fictures and fittings $
b. Contents $
c. Stock in trade $
d. Customers' Goods $
e. Subtotal of items 13b, 13c and 13d $
f. Total $
14. Basis of settlement for Buildings and Contents Reinstatement or replacement Indemnity
Business Interruption
Following an admisable claim under Section 1-Material Damage, Section 3 - Theft or Section 6 - Glass
15. Do You require this section
Yes No
16. Indemnity Period required:
6 months 12 months
Sums Insured
17. Do You require cover for:
a. Gross Revenue and Additional increase in cost of working $
b. Additional increase in cost of working only $
18. Claims preparation expenses: $
Optional Benefit
19. Annual rental income: $
Theft
20. Do You require this Section
Yes No
Note: the most this Policy will pay under this Section is the total sum insured for Contents, Stock in Trade and Customers' Goods under Section 1 - Material Damage, or $500,000, whichever is the lesser
Money
21. Do You require this Section
Yes No
22 Please select a sum insured for Combined Money cover for each item under Tailored Money cover.
Sums Insured
a. Combined Money cover $
Note: This Policy will not pay more than the sum insured for covers 22b (i), 22b (ii), 22b (iii), 22b (iv),or 22c and will also pay up to $1000, or the sum insured, for Combined Money cover, whichever is the lesser
OR
b. Tailored Money cover (Please specify a sum insured for each item)
(i) Money in transit $
(ii) Money contained in the premises during Business Hours $
(iii) Money contained in the premises outside Business Hours $
(iv) Money contained in the premises only whilst contained in a securely locked Safe or securely locked Strongroom $
c. Money in the personal custody of proprietors and authorised employees whilst contained in private residences $
d. Damage to Safes or Strongrooms $
General Property
23. Do You require this Section
Yes No
Sums Insured
24. Unspecified items relating to Your Business (excluding mobile phones, photographic equipment and computer equipment) - maximum value any one item $2000 $
25. Specified items (each valued at $2000 or greater)
1. $
2. $
3. $
4. $
5. $
Total Sum Insured for specified items $
Total Sum Insured for this Section $
Glass
26. Do You require this Section
Yes No
Please indicate cover required
27. Covering fixed external Glass Replacement Cost $
28. Covering fixed internal Glass, fixed and hanging mirrors, wash basins, lavitory pans and cisterns Replacement Cost $
Notes: The cover under either 27. or 28., includes up to $2000 for any one event and in any one Period of Insurance for Damage to window or door frames, tiled shop fronts, Stock in Trade, or for the cost of temporary shuttering and security, sign writing, ornamentation, reflective materials and alarm tapes.
The cover under either 27. or 28. excludes illuminated signs.
29. Covering illuminated signs Sum Insured $
30. What percentage of Glass is located on or above first floor %
Public and Products Liability (Note: Professional Indemnity is excluded in this Policy)
31. Do You require this Section
Yes No
32. State Limit of Indemnity required:
$5 million $10 million $20 million
Note: This is the maximum amount this Policy will pay in respect of any one Occurence provided that, for all legal liabilty directly or indirectly arising out of Your Products, Out total aggregate liability during any one period of insurance will not exceed the Limit of Indemnity
33. Total number of employees:
34. Estimated annual turnover: $
35. Optional Extension: property in Your physical or legal control
Indemnity required $ (This Policy provides automatic cover to a limit of $20,000, unless otherwise advised)


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: