Our business pack question set covers the following sections, click NEXT and complete the form with as many details as possible. Fire & other specified perils Business Interruption Burglary Money Glass Liability Transit Electronic Computer Breakdown Machinery Breakdown General Property Tax Audit Employee Fraud Motor Vehicles Who This Enquiry Is ForFor us to provide the best response to your inquiry please complete the following This inquiry is for an existing business with current insurance This inquiry is for an existing business without insurance This inquiry is for a new business Contact DetailsFirst Name Surname Address Suburb / City Postcode Telephone Mobile Fax Email Business DetailsName of the business Describe your businessWhat is the required start date of the insurance? DD slash MM slash YYYY Is your business premise address different to your contact address? No Yes Business street address Business suburb / city Business postcode Does your business operate from multiple sites? No Yes Age of building in years What is the roof made of? Tile Steel What are the walls made of? Brickwork Concrete Steel on steel Steel on wood What are the floors made of? Timber Concrete What type of alarm system is installed? Monitored Local None Fire & other specified perilsSum Insured Building $ Stock $ Contents $ Others (please specify)Description$ Business InterruptionIndemnity Period 6 months 12 months Sum Insured Gross Profit $ Increased Working Cost $ Wages $ Rent $ Other $ Other Description Total $ BurglarySum Insured Contents $ Stock $ Tobacco $ Combined contents / stock $ Other $ Other Description MoneySum Insured In Transit $ On Premises $ On premises outside $ Business hours $ In Safe $ Personal custody $ Other $ Other Description GlassSum Insured Internal or External Internal - Replacement Value External - Replacement Value Signs $ LiabilitySum Insured Payout $5 Million $10 Million $20 Million Turnover $ Wages Paid $ Staff Numbers $ Are you the property owner? No Yes Describe tenant's business Do you import products? No Yes Product 1 Country of origin 1 Product 2 Country of origin 2 Country of origin 3 Product 3 TransitOwn VehiclesMaximum Value per load $ Annualised Total Carry $ Number of Vehicles # Professional CarriersMaximum Value per load $ Annualised Total Carry $ Electronic Computer BreakdownDescribe equipment you wish to insureSum Insured $ Machinery BreakdownSum Insured RefrigeratorAmount of units Units $ Air ConditionerAmount of units Units $ Other Amount of units Units $ General PropertyDescribe equipment you wish to insure 'away from your business' (e.g. laptop computers)Sum Insured Tax AuditSum Insured $ Employee FraudSum Insured $ Motor VehiclesMake and model Year Registration Number Main Driver Date Of Birth DD slash MM slash YYYY The vehicle is garaged No Yes Garage postcode NCB rating or rating number Use Business Private Under Finance No Yes Final QuestionsPrior to the Insurer accepting any risk they will require information about any claims over the past 5 years where the claims relate to the type of insurances you wish to take out. Please describe those claims:Email a copy to me Tick for yes EmailThis field is for validation purposes and should be left unchanged. Δ
