On-line Pest Controllers Public and Products Liability Insurance


Thank you for considering our on-line pest controllers 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 pest controllers public and products liability insurance for you.deal.

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 the occupation:
4. Area/Location:
5. Number of years in this business under this name:
6. Previous industry experience if less than five years in business:
7. Are you represented outside Australia?
Yes No
If Yes, please provide details:
8. Details of all claims or incidents in the past 5 years (incl. Contributing deductibles):
9. Existing deductible: $
10. Estimated annual Turnover, split by occupation, if applicable:
11. Estimated annual wages: $
12. Are Labour Hire personnel engaged by the Insured under a Contract of Service?
Yes No
If Yes, please advise estimated payments to such personnel and the activities performed:
13. Do hired personnel work under the supervision of the Insured or that of the provider?
Insured Provider
14. Are Contractors or Sub Contractors engaged by the Insured?
Yes No
If Yes, please advise estimated payments to such personnel and the activities performed:
15. Estimated percentage of payroll split between work at and away from the Insured's premises:
At premises: % $
Away from premises: % $
16. Do you agree to indemnify or hold harmless any other parties, by written agreement or otherwise?
Yes No
17. Limit of Indemnity: $
18. Please provide details of the type of premises sprayed, split by % of revenue from each:
19. Pests eradicated:
20. Chemicals/preparations used:
21. Does the Insured mix chemicals or provide directions on formulation to clients?
Yes No
22. Does the Insured use electronic weather and GPS systems, where applicable, to ensure correct location and conditions for spraying?
Yes No
23. Is equipment cleaned after completion of spraying or when chemical mix is altered?
Yes No
24. Please list major items of equipment used by the Insured:
25. Does the Insured operate to relevant Australian Standards for the industry involved?
Yes No


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: