On-line Professional Pest Managers "Claims Made" Public Liability and Professional Indemnity Liability Insurance


Thank you for considering our on-line pest managers public liability and professional indemnity 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 managers public liability and professional indemnity 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. State fully the nature of your business including the number of years experience in this business:
4a. Do you carry out Urban Pest and Weed Control Work as part of your business?
Yes No
4b. Urban Pest and Weed Control Work as a % of your business %
4c. If You carry out Urban Pest and Weed Control Work have You been assessed as competent in the National Pest Management Industry, Competency Standards, Units 5 & 6?
Yes No
4d. Do you hold qualifications from a TAFE course or equivalent course in Urban Pest and Weed Control?
Yes No
4e. Do you hold a State licence pertaining to Urban Pest and Weed Control Work?
Yes No
4f. How many people in Your organisations carry out Urban Pest and Weed Control Work?
5a. Do you carry out Termite Work as part of your business?
Yes No
5b. Termite Work as a % of your business %
5c. If You carry out Termite Work have You been assessed as competent in the National Pest Management Industry, Competency Standards, Certificate II - Technical Plus Units 8 & 10?
Yes No
5d. Do you hold qualifications from a TAFE or AEPMA timber pest inspection course?
Yes No
5e. Do You meet the minimum recommended inspection experience standard set out in AS4349.3 i.e. 40 timber pest reports under the direct supervision of a timber pest inspector with two years practical experience in the area of timber pests?
Yes No
5f. Do you hold a State licence pertaining to Termite Work?
Yes No
5g. How many people in Your organisation carry out Termite Work?
6a. Do you carry out Timber Pest Work as part of your business?
Yes No
6b. Timber Pest Work as a % of your business %
6c. If You carry out Timber Pest Work have You been assessed as competent in the National Pest Management Industry, Competency Standards, Unit 8?
Yes No
6d. Do you hold qualifications from a TAFE or AEPMA timber pest inspection course?
Yes No
6e. Do You met the minimum recommended inspection experience standard set out in AS4349.3 i.e. 40 timber pest reports under the direct supervision of a timber pest inspector with two years practical experience in the area of timber pests?
Yes No
6f. Do you hold a State licence pertaining to Timber Pest Work, where applicable?
Yes No Not Applicable
6g. How many people in Your organisation carry out Timber Pest Work?
7. Please describe any other type work your business undertakes:
8. Are You currently accredited to use the RSA Handbook System pertaining to Your work? (If No , please refer to the RSA 'Professional Pest Managers Overview' for accreditation details. Importantly, insurance will not be offered if You are not accredited to use the RSA Handbook System.)
Yes No
9. Do You issue computer generated paperwork to consumers (i.e. inspection reports)?
Yes No
10. Do You use sub-contractors?
Yes No
As the policy does not cover sub-contractors, if Yes, what steps do You take to check that sub-contractors employed by You hold adequate PI & PL insurance? Please provide details of their insurance, limit of liability and insurer details?
11. During the past 6 years, did You operate under a different name, or has any other business been purchased or any merger or consolidation taken place?
Yes No
If Yes, please supply details, including the names of the individuals or firms involved and the date the activity occurred and the date of variation:
12. Details of all Partners/Principals:
Full Name Age Qualification/Association Membership Date Qualified
13. How long as a Principal and/or Partner?
Full Name Current Practice Previous Practice
14. Details of Staff numbers by order of Qualification and Experience:
Staff - Qualified & Experienced Category Number of
Staff		 Nature of Work & Activity
15. Is work undertaken outside of Australia or New Zealand?
Yes No
If Yes, provide brief particulars:
16. Gross fees last 12 months: $
17. Estimated gross fees next 12 months: $
18. If one client or contract accounts for more than 20% of Your gross fees, please advise percentage and explain nature of Your relationship with that Client:
19. Have you entered into any contract or agreement (including any in respect of the supply of raw materials, components or finished goods) under which you have assumed liability for which you would not otherwise be liable, or under which you have waived your legal rights of recovery (e.g. hold harmless agreements)?
Yes No
If Yes, please provide details:
20. Do you work with or make use of chemicals, gases, inflammables, explosives or other dangerous substances?
Yes No
If Yes, please provide details:
21. Does the company currently carry:
21a. Professional indemnity insurance (PI):
Yes No
21b. Public Liability insurance (PL):
Yes No
22. If you answered No to 21a or 21b, has the company every been so insured?
22a. Professional indemnity insurance (PI):
Yes No
22b. Public Liability insurance (PL):
Yes No
23. If you answered Yes to 21 or 22, please provide:
PI PL
i. Amount of cover: $ $
ii. Premium: $ $
iii. When lapsed or expiry date:        
iv. Name of Insurer:        
v. Number of years insured: $ $
24. Is your previous Public Liability policy underwritten on a Claims Made or Occurrence wording?
Claims Made Occurrence
25. Have you in the past, either alone or in partnership or jointly with any party, or if a corporation, any of its directors:
25a. Had any insurer decline any claims submitted?
Yes No
25b. Had any insurer decline any Proposals submitted?
Yes No
25c. Ever been bankrupt?
Yes No
25d. Been convicted of or charged with any civil or criminal offence?
Yes No
If you answered Yes, to any of the above, please provide full details:
26. Have you or any other parties noted as the Insured ever had insurance refused or cancelled or has any insurance company ever imposed special terms, conditions or restrictions on your policies?
Yes No
If Yes, please provide full details:
27. Detail all insurance claims made in the last five years together with any uninsured losses. Please include dates and amounts. Please also include details of any known facts or circumstances which are reasonably likely to give rise to a claim in the future, even if no claim has yet been made:
Year notified Insured With Claimant Nature of Problem Amount Paid
and/or Outstanding
28. Please provide a breakdown in the number of employees by location as follows:
NSW  VIC  QLD  SA  WA  TAS  NT  ACT  Overseas
%  %  %  %  %  %  %  %  %


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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