On-line Waste Contractors Public and Products Liability Insurance

Thank you for considering our on-line waste 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 waste 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
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 your own premises:
At premises: % $
Away from premises: % $
16. Is work performed away from your premises?
Yes No
If Yes, please provide details of such work, including duties undertaken, sites worked on and estimated % of turnover derived from such work:
17. Is any work performed on the following sites:
% of turnover derived from work on site
Underground sites
Oil or gas production facilities
Chemical works
Security sensitive sites
If any of the sites have been selected, please provide a full description of work performed:
18. What type of waste is handled, split by % of work performed on each major class of waste handled:
19. Please provide full detail of handling procedures and risk management details for any prescribed or hazardous waste involved in the Insured's work:
20. Is waste disposed of only at authorised sites and disposal facilities?
Yes No
21. Do you agree to indemnify or hold harmless any other parties, by written agreement or otherwise?
Yes No
22. Limit of Indemnity: $
23. 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:
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: