INSURANCE DETAILS

Project Period

Project Value

Contract Value

Public Liability
Select$10 Million$20 Million

Material Damage Excess (higher excess reduces premium)
$1,000$2,500$5,000

Legal Liability Excess
$2,000$3,000$5,000$10,000

Financial Interested Party

Do you require insurance cover for existing structures?

YesNo

If Yes, what is the replacement value of the existing structures?

Policy Start Date

Description of business activity (Ensure percentage total equals 100):

UNDERWRITING QUESTIONS

Have you or any proposer, any partner(s), shareholder(s) or director(s) of the business:

1. Made 2 or more claims on an insurance policy?

YesNo

2. Had any insurance declined or cancelled?

YesNo

3. Suffered any loss or damage greater than $50,000?

YesNo

Have you or any partner(s), shareholder(s) or director(s) of the business:

4. Ever been declared bankrupt, insolvent or placed into administration?

YesNo

5. Been convicted of any criminal offence?

YesNo

Do you undertake or assume responsibility for any of the following:

6. Projects Valued Over $5,000,000

YesNo

7. Any commenced work

YesNo

8. Civil works and/or earth works exceeding $50,000?

YesNo

9. Excavation more than 5 metres in depth?

YesNo

10. Any work outside mainland Australia and Tasmania?

YesNo

11. Swimming pool / landscaping / waterproofing only contracts?

YesNo

12. Excavation more than 5 metres or work over 5 stories?

YesNo

13. Works on, in, over or under water?

YesNo

14. Work involving special hazards?

YesNo

15. Work around aircraft or watercraft?

YesNo

16. Work with asbestos?

YesNo

17. Work involving piling, shoring or underpinning?

YesNo

18. Work to heritage buildings?

YesNo

19. House raising, restumping or relocating?

YesNo

20. Vacant land liability greater than 2 lots?

YesNo

21. Responsibility assumed from another builder?

YesNo

22. Existing structures with risks listed?

YesNo

23. Existing structures with multi occupancies?

YesNo

24. Erection of machinery or plant?

YesNo

25. Demolition works?

YesNo

26. Labour Hire company activities?

YesNo

27. Prototype or experimental materials or methods?

YesNo

28. Educational institutions, medical complexes or shopping centres?

YesNo

29. Work outside mainland Australia and Tasmania?

YesNo

30. Swimming pool, landscaping or waterproofing only contracts?

YesNo

Provide any additional information that may assist with your application

General Advice
Please be aware that any advice that may have been given or implied is general advice only. We have not taken into consideration your individual needs, objectives or financial requirements. Before deciding to purchase a financial product, you should consider the appropriate Product Disclosure Statement to ensure the product is suitable for your needs.

Declaration
Duty to not Misrepresent.

Your duty when you apply for insurance.

Before you enter into an insurance contract, you have a duty of disclosure under the Insurance Contracts Act 1984.

By law, you must take reasonable care not to make a misrepresentation. This means giving us true, complete, and accurate answers to our questions, including where you provide information on someone else’s behalf.

We use your answers to decide whether to insure you and on what terms.

If you do not tell us something If any of your answers are misleading, incomplete,inaccurate, or fraudulent we may reduce or not pay a claim, cancel your policy, or treat it as if it never existed.

If you don’t understand a question, you’re unsure how to answer or if anything is unclear, please contact us immediately.

I have read and agree to the above declaration.