On-line Trade Insurance


Thank you for considering our on-line trade 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 trade 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. How many years have You been in: this Business? any similar business?
3a. Interested Parties in Your Tools of Trade and Office Contents:
3b. Nature of their interest: Mortgage Owner Lessor Bill of Sale Other
4. Interested Parties' addresses:
5. Do you maintain details records of puchases and sales?
Yes No
6. Are Your books audited by a qualified accountant at least annually?
Yes No
7. 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
c. had an application for a loan declined in the past two years?
Yes No
If You have answered Yes to either part of this question, please provide full details:
8. Previous Insurance
a. have You held previous business insurance for any business?
Yes No
If Yes name of previous insurer:
b. have You 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:
9. 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
$ $
$ $
$ $
$ $
$ $
General Property
10. Do You require this Section? (If Yes choose either Part A or Part B)
Yes No
11. Part A - Accidental damage and fire
Any sudden or unexpected or unforseen occurrence not otherwise excluded.
a. Specify items Sums Insured
$
$
$
$
$
Total Sum Insured $
Part B - Restricted Cover
1. Fire (Whether resulting from explosion or otherwise)
2. Collision and/or overturing of the conveying vehicle; and
3. Flood.
Situation of the Property Insured - anywhere in Australia
Property Insured (list any item to be insured which is valued at $2,000 or greater)
b. Description of Property Insured: Sums Insured
(i) Unspecified items or tools relating to Your trade or profession (excluding mobile phone, photographic equipment and computer equipment) - maximum value any one item $2,000. $
(ii) Specified items
$
$
$
$
$
Subtotal of Specified items $
(iii) Stock in Trade (including Customers' Good and items held in trust or on commission) $
(iv) Office Contents $
Total Sum Insured $
Public and Products Liability
12. Do You require this Section
Yes No
Public Liability
Yes No
13. State Limit of Indemnity required:
$5 million $10 million $20 million
14. Number of staff (including working proprietors):
15. Annual turnover: $
16. Annual wages: $
17. Professional or other services.
Do You provide any professional, technical, consultancy, advisory or like services either for a fee or as an ancillary service to your business?
Yes No
If Yes give details of such services and to whom such services are offered. Note: Professional Indemnity is excluded in this Policy:
18. Description of contractual liability exposure.
Have You assumed any obligations under any contracts or agreements, including hold harmless or indemnification agreements?
Yes No
If Yes, and You require cover for any such contracts or agreements entered into, these must be listed below. Such exposures are excluded in this Policy, unless specifically noted in the Schedule:
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)
Note: A higher Excess applies
19. Description of property in Your physical or legal control
a (i). List all non-owned premises, e.g. real property occupied under lease or rental agreements:
Location Type of property Approximate value
$
$
$
(ii). List all property of others in Your care, physical or legal control (include details of all good, mechandise or equipment being leased, repaired, serviced, treated or on consignment or bailment):
Location Type of property Approximate value
$
$
$
b. Have any hold harmless or indemnification agreements been executed which relate to the destruction of or Damage ot the property listed above
Yes No
If Yes please provide full details:
c. Does any other person (financier, lessor, etc) have any interest in the property and/or goods stated in (a) above?
Yes No
If Yes please provide full details:
Product Liability
Yes No
20. Products
a. Please describe fully the types of products manufactured, sold, handled, treated, hired out and/or the type of services that are performed for others:
b. Do You design parts of completed components for others?
Yes No
c. Do You manufacture to the designs, formulae, plans and/or specifications of others?
Yes No
d. Have product brochures been published?
Yes No
e. (i). IMPORTS: Please supply details of all imported goods, including the use of such goods and the country(s) of origin:
(ii). Percentage of turnover derived from such goods: %


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: