Public & Products Liability Insurance Quote

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

Your Details
Name *
Name
Phone *
Phone
Insured Details
Entity / Trading Name(s) / Business Commencement Date
Business Address *
Business Address
http://
Periods and Limits of Insurance
Insurance cover is needed from: *
Insurance cover is needed from:
Insurance cover is to cease: *
Insurance cover is to cease:
for any one occurrence
$
annual aggregate
$
$
Business Particulars
Years / Months
Turnover / Payroll
$
$
Including earnings of directors and partners
$
Business Operations Outside Australia
Do you operate outside Australia? *
Sub-contractors
Do you use sub-contractors? *
$
Are sub-contractors required to carry their own liability insurance?
$
Do you always check the insurances of sub-contractors?
Products
Do you manufacture, supply, distribute or sell any products?
Include product, use of product, and estimated turnover for the next 12 months. Please email product brochures or other relevant documents to admin@doringinsurance.com.au
Do you maintain records of the origin of all components of your products?
USA and CANADA
Have you given Power of Attorney to any person or corporation in the USA or Canada? *
Do you have any assets/company located in the USA or Canada? *
Do you have any employees or other representatives in the USA or Canada? *
Do you export to USA or Canada? *
Contractual Liability
Have you entered into any contracts or agreements where you have assumed the liability of others or released others from liability (hold harmless)? *
NOTE: This insurance does not cover such liability unless agreed by the Companies. Please email a copy of such contracts and agreements (if cover is required) to admin@doringinsurance.com.au. An extra premium may apply.
Use of Certain Machinery / Chemicals etc
Include details of chemical name, quantity, and details of storage
Do you (employees or sub-contractors) carry out any hot works? *
If 'Yes', do your safety procedures comply with the Australian Standards? *
Claims / Insurance History
Do you currently have insurance? *
During the past five years, have you ever had a claim made against you, or are you aware of any incident, accident or prosecution which could lead to a claim being made against you (whether insured or not)? *
Include date, particulars, cost, and name of insurer (if any)
Has any insurer ever declined indemnity for any claim made by you? *
Has any insurer declined, refused to renew, cancelled or imposed special conditions to any policy of insurance held by you? *
Additional information
Declaration
Declaration for an 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.