Commercial - Retail - Industrial
Insurance Quote

Complete the following form, and our team will respond to you within 1 working day.

Your Details
Name *
Name
Phone
Phone
The Insured
Name of Insured *
Name of Insured
Registered Business *
Postal Address *
Postal Address
Business Phone Number *
Business Phone Number
http://
e.g. Mortgagees or Lessors
Period of Insurance to commence: *
Period of Insurance to commence:
Period of Insurance to cease: *
Period of Insurance to cease:
General Information
Have you (in the past 5 years) made any claim(s) on an insurer for loss or damage? *
Include name of insurer, dates, amount in $'s, and reason for cancellation
Have you (in the past 5 years) had any insurance declined or cancelled, application rejected, renewal refused, claim rejected, special conditions or excess imposed by an insurer? *
Include name of insurer, dates, amount in $'s, and reason for cancellation
Have you (in the past 5 years) suffered any loss or damage which would have been covered by the proposed insurance policy? *
Have you or any partner(s), shareholder(s) or director(s) of the business ever been declared bankrupt? *
Have you or any partner(s), shareholder(s) or director(s) of the business ever been involved in a company or business which became insolvent or subject to any form of insolvency administration (e.g. liquidation or receivership)? *
Have you or any partner(s), shareholder(s) or director(s) of the business been convicted of any criminal offence within the past 5 years (other than minor traffic convictions)? *
Have you or any partner(s), shareholder(s) or director(s) of the business been liable for any civil offence or pecuniary penalty (exceeding $5,000)? *
Details of your business and premises
Location
Location
(if different to postal address)
Construction of premises
SURVEY DETAILS
A survey/inspection of your premises may be required. Please supply the name and contact telephone number of the appropriate contact person, with whom an appointment can be made.
Number of Years
Tenants Details
Changes in tenancies and the types of business conducted must be notified to us in writing as they occur. Failure to do so many affect your entitlement to claim benefits in the event of loss or damage. NOTE: You must advise us if any unit is unoccupied in excess of 60 days.
Fire and Theft Protection
PLEASE ANSWER THE FOLLOWING AS THEY APPLY TO THE SECTION OF PREMISES OCCUPIED SOLEY BY YOU
Connection to mains water supply? *
Fire sprinkler system? *
Fire hoses? *
Deadlocks on all external doors? *
Locks/bars/grills on all external windows? *
PROPERTY SECTION
$
$
instead of the automatic $25,000
$
$
Is the Policy to the Mortgagee Protection only?
Business Interruption Section
(number of weeks/months as chosen above)
Money payable to you for goods sold/services rendered or rentals, less purchase cost of stock.
$
(instead of the automatic $5,000)
$
$
$
Theft Section
excluding tobacco, cigarettes & cigars
$
$
$
instead of automatic $2,000
$
if applicable
$
if applicable
Money Section
$
$
$
$
$
$
$
Additional covers available
Please include amount when cover required
Maximum $40,000
$
Maximum $20,000
$
Machinery Breakdown Section
Note: Fire and Perils risks are to be insured under the Property Section. Theft risks are to be insured under the theft section.
Do you require cover for breakdown of machinery, plant, boilers and pressure vessels?
Limit of indemnity is $10,000
$
Note: no plant must exceed 4Kw/5hp
Electronic Equipment Section
Note: Fire and perils risks including theft are to be insured under the property section. Theft risks are to be insured under the theft section. Indemnity period is 3 months, excess 2 working days for increased cost of working cover
Include make, model and serial numbers. If list is extensive, please email spreadsheet to admin@doringinsurance.com.au
$
$
$
Broadform Liability Section
Limit of Indemnity
$
include commission and other earnings
$
$
in square metres
$
ie. retail, offices, industrial, residential
Excluding registered vehicles. Instead of the automatic $100,000.
$
$
$
About your products (note: exports to usa/canada are not covered)
Do you sell or distribute any product of a type not normally associated with your business/occupation?
Do you manufacture, pack or relabel any products which you sell or distribute?
Do you import products or raw materials?
Are your products manufactured to comply with any Federal or state regulation or recognised International Standard or Code?
Glass Section
Internal Glass?
External Glass?
ie. factory, warehouse, retail, office
in square metres
$
General Property Section
Accidental Loss or Damage (Standard Cover)
Please indicate if reduced cover Option A (Fire, Theft, Collision and other Expressed Perils) is required:
Fire, lightening, explosion, malicious damage or vandalism; theft following forcible and violent entry which causes visible damage to a locked vehicle or premises; theft of equipment, which is securely attached to a vehicle through use of locks or padlocks, which results in visible damage to the securing devices; collision or overturning of the conveying vehicle.
include Sum Insured for each item
Maximum $20,000
$
Excess Option
Premium can be varied following excess choices
Note: These excess amounts when selected apply to all sections of the policy that are operative (except Broadform Liability for bodily injury claims)
Workers Compensation
Workers' compensation is compulsory in all states and territories of Australia. This package does not include Workers' Compensation. Do you wish to be supplied with a quotation/further information regarding Workers' Compensation?
Note: Not applicable for Queensland and South Australia
Additional Information
Declaration
Declaration for and on behalf of Named Insured *
I/We declare and warrant that after enquiry all statements and particulars contained in this proposal and addenda are true and that no information whatever has been withheld which might increase the risk of the Underwriters or influence the acceptance of this proposal and should the above particulars alter in any way I/We will advise the Underwriters as soon as practicable. I/We understand that failure to disclose any material facts which would be likely to influence the acceptance and assessment of the proposal may result in the Underwriters refusing to provide indemnity or voiding the policy in every respect.