On-line Cleaning Contractors Public and Products Liability Insurance


Thank you for considering our on-line cleaning contractors public and products liability 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 cleaning contractors public and products liability 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.


Limit of Liability Required:
1a. Please select the amount of Liability cover required:
$5,000,000 $10,000,000 $15,000,000 $20,000,000
1b.
Public Liability (any one occurrence)
Products Liability (each Period of Insurance)
2. Do you currently have Public Liability insurance?
Yes No
If Yes, please provide details below:
Expiry Date
Insurance Company
Indemnity limit $
Excess $
Premium $
Business Details:
3. Full Description of Occupation:
4. Area of Operation:
5. Number of years in this business under this name:
6. Previous industry experience if less than five years in business:
7. Details of all claims or incidents in the past 5 years (incl. Contributing deductibles):
8. Estimated annual Turnover:
After Hours Cleaning: $
Cleaning of retail or common areas during business hours: $
Other activities: $
Please specify details of other activities:
9. Estimated annual wages: $
10. Are Labour Hire Employees engaged by the Insured under a Contract of Service?
Yes No
If Yes, please advise estimated turnover and wages relating to these contracts and the activities performed by such persons:
11. Are Contractors or Sub Contractors engaged by the Insured?
Yes No
If Yes, please advise estimated turnover and wages relating to the contracts and the activities performed by such persons:
12. Is the Insured contracted to perform spot cleaning of spillages during operational business hours?
Yes No
13. Does the Insured utilise an electronic or manually recorded method of checking inspection or attendance times?
Yes No
If Yes, please provide brief details:
14. Please provide details of plant and equipment used by the Insured:
15. Are any ride-on items of Plant used?
Yes No
16. Do you agree to indemnify or hold harmless any other parties, by written agreement or otherwise?
Yes No
17. Are there any discontinued products not listed above?
Yes No
If Yes, please provide details:
18. Limit of Indemnity: $
19a. What type of chemicals does the Insured use in cleaning activities?
19b. Are they mixed or blended by the Insured, other than to supplier's specific instructions?
Yes No
20. Please attach or provide details of the Insured's Incident Report System:
21. Is any work performed on the following sites:
% of turnover derived from work on site
Underground sites
Mines
Airfields/Airports
Air or Watercraft
Oil or gas production facilities
Chemical works
Wharves/Docks
Controlled atmosphere workplaces
Security sensitive sites
Banks
If any of the sites have been selected, please provide a full description of work performed:


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: