Get a Quote - High Street Underwriting Agency

Broker Details

Brokerage Name

Broker Contact Name

Broker Contact Email

Broker Contact Phone

If you have an existing proposal form you would like to upload, please add it here - you may skip the rest of the form and submit with your own form.

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Insured's Details

Insured / Business Name

Insured's First Name

Insured's Last Name

Insured's Street Address

Insured's Suburb

Insured's State

Insured's Postcode

Insured's Website

Insured's Business Description

Include descriptions of all occupations and activities AT THE PREMISES

Insurance Details

Type of Insurance Needed

Policy Start Date

Area of Liability

Public Liability Limit Required

Insured's Estimated Payroll

Estimated Annual Turnover

(enter estimated annual turnover for the next 12 months)

Number of Manual Workers

(employees and labour-only subcontractors including the insured who carry out manual work. Exclude any clerical/office workers)

Please advise the "Any One Accident" limit required:

Please provide full details of the plant and equipment:

What is the total new replacement value of contractors plant and equipment owned by the business?

What is the total market value of the plant and equipment?

Estimated Annual Turnover

(enter estimated annual turnover for the next 12 months)

What is the maximum estimated value in respect of any one contract?

What is the average estimated value in respect of any one contract?

What is the maximum estimated contract period in respect of any one contract?

What is the average estimated contract period in respect of any one contract?

What is the total value of all employees tools to be insured?

Area of Professional Indemnity

Professional Indemnity Limit Required

Does the insured charge a separate fee for advice?

Yes

Number of Principals or Directors providing advice

Current Retroactive Date

Area of Operation

Public Liability Limit Required

Professional Indemnity Limit Required

Does the insured charge a separate fee for advice?

Yes

Number of Principals or Directors providing advice

Estimated Annual Turnover

(enter estimated annual turnover for the next 12 months)

Number of Manual Workers

(employees and labour-only subcontractors including the insured who carry out manual work. Exclude any clerical/office workers)

Property Area

Policy type

Limit of liability (any one claim)

Business commencement Date

Are any of the properties heritage protected?

Yes

Approximately what percentage of the properties consists of Expanded Polystyrene (EPS)?

Is the insured insuring their own property?

Yes

Situation 1 Address:

Address

Suburb

State

Postcode

Does the insured have any adjoining neighbouring buildings?

Yes

Neighbour Activities

Provide a full description of the activities done by the insured's adjoining neighbours in the same complex if applicable

Are you the owner of the aircraft?

Yes

Describe the nature of your interest

State name of any other person, firm or company having a financial interest in or a lien on the aircraft and describe the nature of that interest

Aircraft 1 details:

Make and model

Year manufactured

Reg.marks

Passenger seats

Purchase price

Date of purchase

Market value

Hours flown

Amount to be insured

Additional Cover

Professional Indemnity Limit Required

Does the insured charge a separate fee for advice?

Yes

Number of Principals or Directors providing advice

Is Contract Disputes cover required?

Yes

Please provide details of the contracts

Please attach a copy of the contract

Add a file...

Is Legal Expenses cover required?

Yes

Errors & Omissions Limit Required

Statutory Liability Limit Required

Tools of Trade Limit Required

Additional Cover

Is loading, transit and unloading cover required?

Yes

Is liability required whilst plant is let out on hire or loan?

Yes

Additional Cover

Is Contract Disputes cover required?

Yes

Please provide details of the contracts

Please attach a copy of the contract

Add a file...

Is Legal Expenses cover required?

Yes

Errors & Omissions Limit Required

Statutory Liability Limit Required

Tools of Trade Limit Required

Fire and Allied Perils

Material Damage - Sum Insured

Material Damage

Sum Insured

Material Damage

Sum Insured

Material Damage

Sum Insured

Building Information

No. of storeys in building

Building construction date (approximate)

When was the building last rewired?

General Construction Details

Wall construction material

Describe the wall materials used:

Floor construction material

Describe the floor materials used:

Fire & Security Details

Describe fire detection equipment:

What is the distance to the nearest police station?

What is the distance to the nearest fire brigade?

What is the nature of the insured's locale protection?

City or town with reticulated water supply & full time brigade

Town with reticulated water supply & volunteer brigade

Area with no reticulated water supply with a fire fighting service

Area with no reticulated water supply or fire service

Provide details about the insured's fire protection:

Which fire suppression system does the building use?

Sprinklered risks (regularly serviced and reliable water supply)

Monitored hardwired smoke/heat detectors

Hose reels / hydrants (reliable water supply)

Other

Provide details about the building's fire suppression system:

Security

External door security features:

Dead bolts

Dead locks

Padlocks

Other key locks

Other

External window security features:

Bars / Grills

Key locks

Other

Burglar alarm security features:

Local alarm only

Dialler

Securitel

Dedicated landline

GSM back up

No alarm

Is a night watchman / security guard employed?

Yes

Other Property Risks

Is there any history of malicious damage to the premises?

Yes

Provide details about the damage to the building:

In what type of area is the premises situated?

Residential

Yes

Commercial

Yes

Industrial

Yes

Rural

Yes

Does the insured occupy the whole building?

Yes

Which part of the building does the insured occupy?

What is the occupancy of the other parts of the building?

Does the insured use any forms of portable heating?

Yes

Please specify the forms of portable heating:

Additional Questions

Modifications, Extra or Special Equipment

Equipment Name

Aircraft 1 (no. of units)

Conditions of Aircraft

Is the aircraft in good condition?

Yes

Is there any unrepaired damage?

Yes

Give details about any unrepaired damage

Aircraft Location

Is the aircraft hangared?

Yes

Range of operation

'Australia' means continental Australia and extending 50 miles into territorial waters, external territories (excluding Australian Antarctica, Macquarie Island, Heard Island, and MacDonald Island) and passage between continental Australia and the external territories (other than the excluded territories)

Name of organisation maintaining aircraft

Purpose of Use The approximate number of hours for each use over the next 12 months

Usage

Aircraft 1 (no. of hours)

Usage

Aircraft 1 (no. of hours)

Usage

Aircraft 1 (no. of hours)

Usage

Aircraft 1 (no. of hours)

Usage

Aircraft 1 (no. of hours)

Usage

Aircraft 1 (no. of hours)

Usage

Aircraft 1 (no. of hours)

Usage

Aircraft 1 (no. of hours)

Usage

Aircraft 1 (no. of hours)

Usage

Aircraft 1 (no. of hours)

Special Hire / Rental Uses

Is the aircraft hired or rented to other persons, firms or organisation for other than private pleasure or business uses?

Yes

Name of hirer or renter

Describe special uses permitted under the hire/rental agreement

Describe flying experience of pilots allowed under the agreement

Estimated number of hours involved in next 12 months

Previous Insurance

Have you previously held an aircraft insurance policy?

Yes

*You or a corporation of which you were a director or, if the proposer is a corporation, a person who is a director of the proposer

Name of insurer

Poicy number

Expiry date

Has any insurer cancelled, declined or refused to renew any such insurance policy?

Yes

If 'Yes' please provide details about cancelled, declined or refused insurance policy

Pilot Information

*Required for all pilots who operate the aircraft

Pilot 1 details:

Pilot's name

Age

Type of licence

Ratings

Flying experience in command

Experience

Pilot 1 (no. of hours)

Experience

Pilot 1 (no. of hours)

Experience

Pilot 1 (no. of hours)

Experience

Pilot 1 (no. of hours)

Experience

Pilot 1 (no. of hours)

Experience

Pilot 1 (no. of hours)

Experience

Pilot 1 (no. of hours)

If pilots are not named, indicate preferred pilot warranty

Provide detail of training courses attended in the last 2 years

Has any pilot named above ever had their licence suspended or cancelled?

Yes

If 'Yes" please provide details about cancelled or suspended licence

Has any pilot named above been convicted of a breach of air navigation safety regulation?

Yes

If 'Yes" please provide details about a breach of air navigation safety regulation

Has any pilot named above been involved in an aircraft accident in the past 5 years?

Yes

If 'Yes" please provide details about an aircraft accident in the past 5 years

Has any pilot named above been convicted of driving a motor vehicle under the influence of drugs or alcohol during the last 5 years?

Yes

If 'Yes" please provide details about any influence of drugs or alcohol to driving a motor vehicle

Loss Experience

Give details of all accidents involving aircraft or liabilities associated with aircraft in which you have been involved in the last 5 years

Convictions

Have you ever convicted of a breach of air navigation safety regulations?

Yes

If 'Yes" please provide details about a breach of air navigation safety regulations

Additional Questions

Does the insured manufacture, supply, distribute or sell any products?

Yes

Please provide details about the related products

Does the insured import any goods?

Yes

Where does the insured import from?

What type of goods are imported?

Does the insured export any goods?

Yes

Where does the insured export from?

What type of goods are exported?

Does the insured use bona fide sub-contractors?

Yes

Approximate percent of work performed by bona fide sub-contractors?

Are sub-contractors required to carry their own liability insurance?

Yes

Does the insured spend any time working outside of Australia?

Yes

Outside of Australia details:

Country

% Time

How many years of experience does the insured have in this industry?

Has the insured or any company the insured was a director of ever been declared bankrupt or insolvent?

Yes

Has any insurer declined, refused to renew, cancelled or imposed special conditions to any policy of insurance held by the insurer?

Yes

Has the insured ever been convicted of or charged (but not yet tried) or been given an Official Police Caution in respect of any criminal offence other than a motoring offence?

Yes

Does the insured's business activities include the supply of labour hire?

Yes

Does the insured conduct work at, in, near, or in connection with:

power stations, nuclear installations or establishments;
refineries, bulk storage or production premises in the oil, gas or chemical industries;
offshore structures or work underground or underwater;
mainframe computers or dedicated computer sites;
aircraft, hovercraft, aerospace systems or watercraft (other than work on watercraft in docks, harbours, boatyards or inland waterways not involving the use of heat);
railway track, railway bridge, railway culvert or crossing;
aerodromes or airports;
tunnels;
handling or removal of asbestos in any form whatsoever;
use of explosives;
bulk fuel storage facility;
high voltage power supply or power generating facility;
grandstands, stages lighting and camera towers at concerts and sporting events;
lifts / elevators

Yes

Additional Questions

How many years of experience does the insured have in this industry?

Has any insurer declined, refused to renew, cancelled or imposed special conditions to any policy of insurance held by the insurer?

Yes

How many years has the business been in existence?

Is any equipment kept in a secure yard / lockup when not in use?

Yes

Additional Questions

How many years of experience does the insured have in this industry?

Has any insurer declined, refused to renew, cancelled or imposed special conditions to any policy of insurance held by the insurer?

Yes

Describe the typical types of contract undertaken:

Provide a full description of the project:

(number of storeys, underground car park, on an incline, above water etc)

Provide details of materials used, dimensions and heights:

(stell frame, steel clad, details of footings etc)

Has the job already commenced?

Yes

Will a swimming pool be constructed?

Yes

Please provide details about the construction of the swimming pool:

Provide information about neighbouring sites/properties:

Will any demolition be occurring?

Yes

Please provide details about the demolition:

Is the client an owner builder or a registered builder?

Will foundations / flooring be included?

Yes

Please provide details about the foundations / flooring:

Will there be piling?

Yes

What precautions are taken to prevent wind / storm damage during construction?

Are there any existing structures?

Yes

Will existing structures be occupied?

Yes

Additional Questions

When was The Insured's company established?

How many directors / officers / partners are there in the company?

Director / Officer / Partner Information

Name

Years in position

Years experience

Qualifications

Name

Years in position

Years experience

Qualifications

number of employees:

Professional Other

Clerical

Total Revenue

Actual last 12 months

Estimated next 12 months

Provide an estimated revenue breakdown by state or territory

ACT %

NSW %

NT %

QLD %

SA %

TAS %

VIC %

WA %

Overseas %

Additional Questions

When was The Insured's company established?

How many directors / officers / partners are there in the company?

Director / Officer / Partner Information

Name

Years in position

Years experience

Qualifications

Name

Years in position

Years experience

Qualifications

number of employees:

Professional Other

Clerical

Total Revenue

Actual last 12 months

Estimated next 12 months

Provide an estimated revenue breakdown by state or territory

ACT %

NSW %

NT %

QLD %

SA %

TAS %

VIC %

WA %

Overseas %

Does the insured spend any time working outside of Australia?

Yes

Outside of Australia details:

Country

% Time

Does the insured use bona fide sub-contractors?

Yes

Approximate percent of work performed by bona fide sub-contractors?

Are sub-contractors required to carry their own liability insurance?

Yes

Has the insured entered into any contracts or agreements where they have assumed the liability of others or released others from liability (hold harmless)?

Yes

Does the insured use unregistered vehicles?

Yes

Please provide details about the unregistered vehicles:

Does the insured use elevators / escalators?

Yes

Please provide details about the elevators / escalators:

Does the insured use cranes and / or other lifting equipment?

Yes

Please provide details about the lifting equipment:

Does the insured use pressure vessels and boilers?

Yes

Please provide details about the pressure vessels / boilers:

Does the insured use hazardous chemicals?

Yes

Please provide details about the hazardous chemicals including quantity and storage:

Does the insured, their employees or sub-contractors carry out any hot works?

Yes

Does the insured's safety procedures comply with the Australian Standards?

Yes

Additional Cover

Glass cover is included in this policy!

Does the insured require consequential loss cover?

Yes

Gross income loss limit / sum insured

Gross income loss indemnity period (in months)

Does the insured require burglary / theft cover?

Yes

Contents cover amount required (excluding tobacco and alcohol)

Does the insured require money cover?

Yes

Location loss limits

Storage location

Limits of any one loss

Storage location

Limits of any one loss

Storage location

Limits of any one loss

Storage location

Limits of any one loss

Storage location

Limits of any one loss

Storage location

Limits of any one loss

Does the insured require accidental or general property damage cover?

Yes

General property item loss limits

Item

Limits of any one loss

Item

Limits of any one loss

Does the insured require fidelity guarantee cover?

Yes

Number of employees

Limit of indemnity required

(Any one occurrence and in the aggregate, maximum limit $50,000)

Does the insured require machinery/boiler and pressure vessel, computer and electronic equipment and deterioration of stock insurance?

Yes

Does the insured require machinery cover?

Yes

Machinery to be Insured Air Conditioning Plant

Equipment

Situation 1 (no. of units)

Equipment

Situation 1 (no. of units)

Equipment

Situation 1 (no. of units)

Other Equipment (add more)

Note: Amount of insurance limited to a maximum of $10,000 any one claim

Does the insured require computer equipment cover?

Yes

Computer equipment to be insured

Computer Equipment

Model

Make

Amount of insurance

Does the insured require electronic equipment cover?

Yes

Electronic equipment to be insured

Electronic Equipment

Model

Make

Amount of insurance

Does the insured require goods in transit cover?

Yes

Value of estimated annual carry

Maximum any one vehicle $5,000

Description of goods being transported

Cover Options

Accidental Damage to Aircraft

Describe Target Cover for Flight, Taxing or Ground Risk if known

Cover 1 details:

Cover Description

Target Deductible Excess

Target Premium

Liability

Legal liability to third parties for property damage and bodily injury

Limit of Indemnity

Property Damage

Bodily Injury

Limit of Indemnity any one passenger

Property Damage

Bodily Injury

Limit of Indemnity all passengers (single limit)

Property Damage

Bodily Injury

Limit of Indemnity-Pilot in command

Property Damage

Bodily Injury

Additional Cover Options

Legal liability to third parties for property damage and bodily injury

*excluding passengers

Airfreight of parts

Property Damage

Bodily Injury

Loss of use

Property Damage

Bodily Injury

Amount of cover per day

Property Damage

Bodily Injury

Passenger liability - Cover in terms of Civil Aviation Act

Yes

Insurance Specific Questions

Does the insured work at or around mine sites?

Yes

Approximate work area split:

Aboveground %

Underground %

Does the insured undertake any of the following occupations / activities?

Blasting and/or shot firing contractor
Dragline operator
Drilling contractor
ERZ controller
Longwall support and/or roof bolting
Mine deputy
Mine relining services
Safety inspector/auditor
Operation of continuous miner
Labour hire

Yes

Approximate work area split:

Residential %

Commercial %

Maximum height worked at

Does the insured clean at shopping centres?

Yes

Does the insured clean while the premises is open to the public?

Yes

Approximate work area split:

Residential % Industrial %

Commercial %

Does the premises ever have live music / a DJ?

Yes

Does the premises have a dance floor?

Yes

Hours of operation:

Day / Period

Hours

Approximate Turnover Split:

Bar % Food %

Pokies % Other %

Approximate welding work area split:

Structural %

Non Structural %

Estimated Airside Turnover %

(enter estimated % of turnover generated from work done airside)

Date Asbestos Removal License Obtained

License Number

Does the insured have and operate a dirty/clean wash room system on site?

Yes

What protective clothing and apparatus does the insured use?

Describe a typical contract and its value:

What method of demolition does the insured use?

Turnover / Gross receipts

Actual last 12 months

Estimated next 12 months

Asbestos removalist (licensed)

Actual last 12 months

Estimated next 12 months

Transport of Asbestos (licensed)

Actual last 12 months

Est. next 12 months

Asbestos waste transfer stations (licensed)

Actual last 12 months

Est. next 12 months

tradepersons working with and/or making safe asbestos

Actual last 12 months

Est. next 12 months

Asbestos testing and/or sampling

Actual last 12 months

Est. next 12 months

Any other non-asbestos activities (eg. demolition, strip-outs, earthworks, shoring/underpinning, trades etc)

Actual last 12 months

Est. next 12 months

Provide a full breakdown of revenue % by activity

Activity

Revenue %

What is the largest fee from a single client?

Has the insured ever undertaken any work for any financial institution, stockbroker, payment processor, investment adviser or personal financial planner?

Yes

Please provide details of the work undertaken for the financial institution etc:

Has the insured ever undertaken any work for any sports or entertainment client?

Yes

Please provide details of the work undertaken for the sports client etc:

Does the insured belong to any association related to any business activities?

Yes

Please list the associations the insured belongs to:

Approximately how many customers does the insured have?

Does the insured carry out work only under a written contract signed by every client?

Yes

Explain in what circumstances, and why, work is not carried out under contract:

Please attach a copy of a typical contract form or example

Add a file...

Are all of the insured's contracts reviewed by an appropriately qualified legal advisor prior to signature?

Yes

Give details on the 5 largest contracts the insured has carried out in the last 3 years:

Contract 1

Client Name

Business Name

Nature of work

Annual income

Start date

End date

Contract 2

Client Name

Business Name

Nature of work

Annual income

Start date

End date

Contract 3

Client Name

Business Name

Nature of work

Annual income

Start date

End date

Contract 4

Client Name

Business Name

Nature of work

Annual income

Start date

End date

Contract 5

Client Name

Business Name

Nature of work

Annual income

Start date

End date

Provide a full breakdown of revenue % by activity

Activity

Revenue %

Provide a full breakdown of revenue % by structure type

Structure Type

Revenue %

Does the insured belong to any association related to any business activities?

Yes

Please list the associations the insured belongs to:

Does the insured engage in actual construction, installation or erection?

Yes

Please provide full construction operating details:

Does the insured engage in any actual manufacture, fabrication or assembly?

Yes

Please provide full manufacturing operating details:

Does the insured assume responsibility for any actual construction, installation, erection, manufacturing, fabrication or assembly?

Yes

Please provide full details about the responsibilities:

In the event that the insured's product or service failed or delivery was delayed please describe the worst case scenario. Consider the potential for loss of life, injury to people, damage to buildings or other tangible property, or financial loss (consequential or otherwise) for the insured's clients:

Approximately how many customers does the insured have?

Does the insured carry out work only under a written contract signed by every client?

Yes

Explain in what circumstances, and why, work is not carried out under contract:

Please attach a copy of a typical contract form or example

Add a file...

Does the insured ever accept contracts with their customers in which they accept liability for consequential loss or financial damages greater than the value of the contract?

Yes

Please explain what percentage of the insured's contracts this is applicable to and what these are capped at:

What approximate percentage of the insured's revenue, in their current financial year, will be paid to sub-contractors?

Does the insured ensure that sub-contractors have their own public liability and professional indemnity insurance?

Yes

Do any of the insured's contracts contain a service credit or liquidated damages regime?

Yes

Please attach an example of a service credit or liquidated damages regime contract:

Add a file...

Are all of the insured's contracts reviewed by an appropriately qualified legal advisor prior to signature?

Yes

Give details on the 5 largest contracts the insured has carried out in the last 3 years:

Contract 1

Client Name

Business Name

Nature of work

Total contract values

Start date

Completion date

Contract 2

Client Name

Business Name

Nature of work

Total contract values

Start date

Completion date

Contract 3

Client Name

Business Name

Nature of work

Total contract values

Start date

Completion date

Contract 4

Client Name

Business Name

Nature of work

Total contract values

Start date

Completion date

Contract 5

Client Name

Business Name

Nature of work

Total contract values

Start date

Completion date

Do any of the contracts listed above include work activity involving units / strata?

Yes

Please state the percentage of overall work involving units / strata:

Provide a full breakdown of revenue % by activity

Activity

Revenue %

Provide a full breakdown of revenue % by structure type

Structure Type

Revenue %

Does the insured belong to any association related to any business activities?

Yes

Please list the associations the insured belongs to:

Does the insured engage in actual construction, installation or erection?

Yes

Please provide full construction operating details:

Does the insured engage in any actual manufacture, fabrication or assembly?

Yes

Please provide full manufacturing operating details:

Does the insured assume responsibility for any actual construction, installation, erection, manufacturing, fabrication or assembly?

Yes

Please provide full details about the responsibilities:

Give details on the 5 largest contracts the insured has carried out in the last 3 years:

Contract 1

Client name

Contract value

Nature of work

Total project value

Start date

Completion date

Contract 2

Client name

Contract value

Nature of work

Total project value

Start date

Completion date

Contract 3

Client name

Contract value

Nature of work

Total project value

Start date

Completion date

Contract 4

Client name

Contract value

Nature of work

Total project value

Start date

Completion date

Contract 5

Client name

Contract value

Nature of work

Total project value

Start date

Completion date

Give details on the 3 largest contracts the insured expects to commence during the next 12 months where they are responsible for the design and other professional services:

Contract 1

Client name

Anticipated contract value

Nature of work

Anticpated total project value

Anticipated start date

Anticipated completion date

Contract 2

Client name

Anticipated contract value

Nature of work

Anticpated total project value

Anticipated start date

Anticipated completion date

Contract 3

Client name

Anticipated contract value

Nature of work

Anticpated total project value

Anticipated start date

Anticipated completion date

Are all of the insured's current contracts progressing on time and on budget?

Yes

Please provide details about progress and budget:

Has the insured ever undertaken a contract as a member of a consortium or a joint venture?

Yes

Please provide details about the consortium or joint venture:

Approximately how many customers does the insured have?

Does the insured carry out work only under a written contract signed by every client?

Yes

Explain in what circumstances, and why, work is not carried out under contract:

Please attach a copy of a typical contract form or example

Add a file...

Does the insured ever accept contracts with their customers in which they accept liability for consequential loss or financial damages greater than the value of the contract?

Yes

Please explain what percentage of the insured's contracts this is applicable to and what these are capped at:

Do all of the insured's current contracts exclude liability for pollution or contamination?

Yes

Please provide details about pollution and contamination liability:

What approximate percentage of the insured's revenue, in their current financial year, will be paid to sub-contractors?

Is the insured responsible for the appointment of sub-contractors?

Yes

Does the insured ensure that any third party undertaking design or specification, any feasibility study, technical information calculation or survey on the insured's behalf have their own public liability and professional indemnity insurance with a limit of liability at least equal to the limit of liability the insured holds?

Yes

Please provide details about third party insurance:

Do any of the insured's contracts contain a service credit or liquidated damages regime?

Yes

Please attach an example of a service credit or liquidated damages regime contract:

Add a file...

Are all the insured's contracts reviewed by an appropriately qualified legal advisor prior to signature?

Yes

Provide the following details in respect of the insured's business for the last complete financial year:

Class of Business

Largest Account Placed

Average Account Placed

Overall Business %

Class of Business

Largest Account Placed

Average Account Placed

Overall Business %

Totals

Largest Account Total

Average Account Total

Overall Business Total

Does the insured belong to any association related to any business activities?

Yes

Please list the associations the insured belongs to:

Approximately how many customers does the insured have?

Does the insured hold any binding authorities?

Yes

Please give details of any binding authorities:

Class of Business

Insurer

Maximum Limit

Full or Limited authority

Gross Premium

Date of last audit

Claims authority Limit

Is any legislation currently in force governing the insured's activities?

Yes

Please give details about legislation:

Does the insured ever accept contracts with their customers in which they accept liability for consequential loss or financial damages greater than the value of the contract?

Yes

Please explain what percentage of the insured's contracts this is applicable to and what these are capped at:

Are all of the insured's contracts reviewed by an appropriately qualified legal advisor prior to signature?

Yes

Provide a full breakdown of revenue % by activity

Activity

Revenue %

Approximately how many customers does the insured have?

State the largest and the average value of properties that you manage, value, lease or sell for each of the past three year:

Year

Largest value

Average Value

Year 1

Largest value 1

Average Value 1

Year 2

Largest value 2

Average Value 2

Year 3

Largest value 3

Average Value 3

Does the insured belong to any association related to any business activities?

Yes

Please list the associations the insured belongs to:

Is any legislation currently in force governing the insured's activities?

Yes

Provide legislation details:

Does the insured carry out work only under a written contract signed by every client?

Yes

Explain in what circumstances, and why, work is not carried out under contract:

Please attach a copy of a typical contract form or example

Add a file...

Does the insured ever accept contracts with their customers in which they accept liability for consequential loss or financial damages greater than the value of the contract?

Yes

Please explain what percentage of the insured's contracts this is applicable to and what these are capped at:

What approximate percentage of the insured's revenue, in their current financial year, will be paid to sub-contractors?

Does the insured ensure that sub-contractors have their own public liability and professional indemnity insurance?

Yes

Do any of the insured's contracts contain a service credit or liquidated damages regime?

Yes

Please attach an example of a service credit or liquidated damages regime contract:

Add a file...

Are all of the insured's contracts reviewed by an appropriately qualified legal advisor prior to signature?

Yes

Provide a full breakdown of revenue % by activity

Activity

Revenue %

Does the insured belong to any association related to any business activities?

Yes

Please list the associations the insured belongs to:

Is any legislation currently in force governing the insured's activities?

Yes

Please give details about legislation:

Give details on the 5 largest contracts the insured has carried out in the last 3 years:

Contract 1

Client Name

Business Name

Nature of work

Annual Income from contract

Start date

Completion date

Contract 2

Client Name

Business Name

Nature of work

Annual Income from contract

Start date

Completion date

Contract 3

Client Name

Business Name

Nature of work

Annual Income from contract

Start date

Completion date

Contract 4

Client Name

Business Name

Nature of work

Annual Income from contract

Start date

Completion date

Contract 5

Client Name

Business Name

Nature of work

Annual Income from contract

Start date

Completion date

Approximately how many customers does the insured have?

Does the insured carry out work only under a written contract signed by every client?

Yes

Explain in what circumstances, and why, work is not carried out under contract:

Please attach a copy of a typical contract form or example

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Does the insured ever accept contracts with their customers in which they accept liability for consequential loss or financial damages greater than the value of the contract?

Yes

Please explain what percentage of the insured's contracts this is applicable to and what these are capped at:

What approximate percentage of the insured's revenue, in their current financial year, will be paid to sub-contractors?

Does the insured ensure that sub-contractors have their own public liability and professional indemnity insurance?

Yes

Do any of the insured's contracts contain a service credit or liquidated damages regime?

Yes

Please attach an example of a service credit or liquidated damages regime contract:

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Are all of the insured's contracts reviewed by an appropriately qualified legal advisor prior to signature?

Yes

Are deep fat fryers installed at the property?

Yes

What type of fryers are installed?

Do the fryers have thermostatic controls or automatic cut off switches?

Yes

Is a fire blanket installed?

Yes

How often are the filters cleaned?

Weekly

Fortnightly

Monthly

Other

How often are the filters cleaned?

Does a professional contractor clean the extraction system?

Yes

How often is the extraction system cleaned?

Claims History

Has the insured had any claims or incidents that may result in a claim in the last 5 years?

Yes

Please provide details:

Claim 1

Date

Amount

Details

Submission

Is there any other underwriting information which you feel is relevant?