LICENSED BUILDERS – ANNUAL INSURANCE COVER

Please select the term of cover you are applying for, from the tabs below

BUSINESS DETAILS

Contact Person

Business Entity Name

Contractors License Number

Phone

Email Address

Street Address

Suburb

State

Postcode

INSURANCE DETAILS

Public Liability

Estimated Annual Turnover

Material Damage Excess (higher excess reduces annual premium)

Legal Liability Excess (higher excess will reduce the annual premium)

Policy Start Date

Financial Interested Party

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

Registered builder undertaking residential construction including new and alterations only

Registered builder undertaking commercial construction including new and alterations only

Registered builder undertaking both residential and commercial including new and alterations only

Registered builder undertaking industrial work Civil contractors

Other (including incidental activities not catered for within the above descriptions)

In which state will your construction activities be carried out in? (Ensure total % equals 100)

NSW

QLD

VIC

ACT

TAS

Above 25th Parallel

Location – where will the majority of the construction works be carried out?

Do you have current insurance in place?

If yes, who is the current insurer?

How many years have you been insured for this business?

Are you eligible for a stamp duty exemption.

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 for loss or damage in the past three (3) years or any claims in excess of $10,000 either individually or cumulatively in the past five (5) years?

YesNo

2. Had any insurance declined or cancelled, application rejected, renewal refused, claim rejected, special conditions or excess imposed by an insurer?

YesNo

3. Suffered any loss or damage which would have been covered by the proposed insurance policy

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. Civil works and/or earth works not associated with a total building contract (incl road or sub-divisions)?

YesNo

8. Excavation more than 5 metres in depth or contracts involving works at height of greater than 5 stories?

YesNo

9. Works on, in, over or under Water?

YesNo

10. Work involving Special Hazards (eg: Blasting or work around petroleum, steel or heavy industries such as automobile manufacturing facilities, mining, petroleum, chemical or steel industries, paper production, power generation, stone, mineral, oil, gas or metal extraction or production, printing or explosive atmosphere processes, tunnelling, micro tunnelling, pipe-jacking, and directional drilling)?

YesNo

11. Work taking place on, in or around aircraft or watercraft ?

YesNo

12. Work with Asbestos?

YesNo

13. Work involving piling, shoring greater than 1m in height or underpinning?

YesNo

14. Work to Heritage Buildings?

YesNo

15. Work involving house raising, restumping or relocating ?

YesNo

16. General Liability for vacant land of more than 2 lots ?

YesNo

17. Where responsibility is assumed from another builder after commencement of works ?

YesNo

18. Product imports / re branding / re packaging?

YesNo

19. Erection of machinery or plant (EAR Risks) unless the component is part of residential or commercial building construction and is less than 20% of the total contract value?

YesNo

20. Demolition Works other than work incidental to the main contract and involving stand alone structures on the contract site not exceeding 10 metres in height?

YesNo

21. Business activities as a Labour Hire company?

YesNo

22. Works involving prototype or experimental materials or construction methods?

YesNo

23. Work involving Educational Institutions, Medical complexes and Shopping centres?

YesNo

24. Work outside of mainland Australia and Tasmania?

YesNo

25. Work involving swimming pool only contracts, landscaping only contracts or waterproofing only contracts?

YesNo

26. Are payments to Labour Hire companies for the next 12 months estimated to be 20% or more of total estimated turnover?

YesNo

Annual Policy – Existing Projects

27. Do you require cover for projects that have already commenced?

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.

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I have read and agree to the above declaration.

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LICENSED BUILDERS – ANNUAL INSURANCE COVER FORM

LICENSED BUILDERS – ANNUAL INSURANCE COVER

BUSINESS DETAILS

INSURANCE DETAILS

UNDERWRITING QUESTIONS