Location

Limit

$5,000,000
$10,000,000
$20,000,000
other

Years in Business

Annual Turnover

Payments made to subcontractors

is work carried out over 10 metres?

yes no

if yes, advise percentage %

Majority Works

% residential

% commercial

Do you perform work on any of the following sites:

Temporary Seating

%

Stages

%

Lighting Towers

%

Camera Towers

%

Concerts

%

Sporting Events

%

Mine site (above or underground)

%

Refinery, gas producing or bulk fuel storage facility

%

High voltage power supply/ power generating facility

%

Airport, airfield or aerodrome

%

Wharf or any form of ship handling or loading facility

%

Railway track, bridge, culvert or crossing

None of the above

Current Insurer

Current Deductible

Expiry date of current insurance

Number of Years Insured

Claims details - summary last 5 years

Ever been declined insurance?

yes no

PLEASE NOTE
This is for the use of NON BINDING INDICATIVE QUOTATION PURPOSES ONLY and is subject to a satisfactorily completed Proposal Form Prior to Binding