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Job Futures - Insurance Quotation Questionnaire

Please note that completion of this questionnaire is not a contract of Insurance.

Instructions for completing the questionnaire:

  • Please complete each Section where information is required and for which you would like a quote.
  • Should any sections not be complete we will contact you to obtain this information or your confirmation not to quote.
  • Should additional information be required we will contact you to obtain this.
  • For those policies which require a proposal form to be completed we will forward this to you for completion when quotes are provided.
  • Should you wish to advise us of any additional information please enter this in the field provided at the bottom of the page.

General Information

Insured Name *
Contact Name *
Postal Address *
Contact Number *
Email *
Date Current Insurance Expires
Business Activities/Programs

 

What policies would you like a quote on?

Industrial Special Risks (property) Yes    No
Liability Yes    No
Not for Profit Liability (PI & D&O) Yes    No
Fidelity/Crime Yes    No
Voluntary Workers/Personal Accident Yes    No
Motor Vehicle Yes    No
Corporate Travel Yes    No

 

Property

Address State Postcode Building
SI		 Contents
SI		 Gross Revenue
SI

 

Liability/Not for Profit Liability
(a proposal form must be completed for acceptance by Insurer)

Address State Postcode Turnover Number
of Employees

 

Fidelity/Crime
(a proposal form must be completed for acceptance by Insurer)

Address State Postcode Number of Employees
in charge of handling money

 

Voluntary Workers / Personal Accident

Activity/Training/Placement Program Estimate annual number
of participants/jobseekers

 

OPTIONAL - Motor Vehicle

Year Description Registration No. State Kept Value

 

OPTIONAL - Corporate Travel

Within Australia ESTIMATED ANNUAL TRIPS
A No. of trips per year
B No. of persons involved
C Average length of each trip (days)
Overseas ESTIMATED ANNUAL TRIPS
A No. of trips per year
B No. of persons involved
C Average length of each trip (days)

 

Additional Details


 
 
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