ACCOMMODATION INSURANCE

Insured entity type *

First Name *

Last Name *

Partnership name *

Company name *

Association or Co-operative name *

If other, please advise *

Trading name (if applicable)

ABN (if applicable)

Email Address: *

Contact Phone Number *

Postal Address: *

Estimated rental income/turnover for the next twelve months *

What year was the business established? *

Number of Full time staff (including ALL Directors/Owners) *

Total number of staff – Part time / Casual *

Occupation and property type *

If other, please provide a description of your property in as much detail as possible *

Property Information

Property Address *

Number of Floors *

Year Built *

Year Re-Wired (If Applicable)

Year Re-Plumbed (If Applicable)

Wall Construction *

Roof Construction *

Floor Construction *

If Other, please provide details of the construction type below: *

Do you wish to note any interested parties/mortgagee?

Does the property contain a Bar or Restaurant? *

Does the property have Deep Frying or Wok cooking? *

NoYes

If yes, please provide details of deep fryer or wok cooking arrangements, including number of Litres for deep fryers *

Public & Products Liability Insurance Section

Limit of Liability Required *

Do you engage with Sub-Contractors to work on your behalf? *

NoYes

Do you engage with labour hire companies to complete work on your behalf? *

NoYes

Do you ensure that contractors and/or subcontractors and/or labour hire firms have their own liability and where necessary, Workers Compensation insurance? *

NoYes

What type(s) of work do contractors and/or subcontractors and/or labour hire firms perform for you? *

Estimate the amount to be paid to contractors and subcontractors and/or labour hire firms in the next 12 months: *

Business Property/Contents Insurance Section

Do you require Building Insurance? *

YesNo

Do you require Contents insurance? *

YesNo

Do you require Stock insurance? *

YesNo

What is the replacement value of your building? *

What is the replacement value of your contents? *

What is the replacement value of your stock? *

Business Interruption/Loss of Rent

Do you require Business Interruption/Loss of Rent cover? *

YesNo

Turnover/Rent for the previous 12 months *

Estimated Turnover/Rent for the coming 12 months: *

Total cost of Purchases and Freight (Last Financial Year)

What growth has been budgeted for in the current financial year? *

Do you expect the same % growth for the next two financial years? *

YesNo

If No, what % is expected? *

Opening Stock

Closing Stock

Theft/Burglary

Do you require cover for Theft of Contents/Stock *

YesNo

Please specify the sum insured you would like for Theft/Burglary cover: *

Glass

Do you require cover for Glass? (please note that Glass is not included in building cover above) *

YesNo

General Property (portable property)

Do you require General Property cover for Portable items covered Australia Wide? *

YesNo

Please specify the collective sum insured you would like for General Property items under $2,500 in individual value

Please specify any items you would like insured that are over $2,500 in individual value:

Item description:

Sum Insured:

Machinery Breakdown

Do you require Machinery Breakdown cover? *

YesNo

Number of Machinery Items including Air Conditioners to be Insured *

Please specify the sum insured you would like for Machinery Breakdown Cover? *

Do you require Deterioration of Stock cover? *

YesNo

Please specify how much Stock you would like covered: *

Other Insurances

Declaration

Have you had any Insurance claims in the past 5 years? *

NoYes

Date of loss/incident *

Description of incident *

Amount Paid *

Was the claim for this property? *

NoYes

Have you or any directors been charged or convicted of any criminal offence? *

NoYes

If yes, please provide details of criminal offences *

Have you or any Directors of the business had any claims refused? *

NoYes

If yes, please provide details: *

Have you or any Directors of the business had any Insurance cover declined, cancelled or special conditions imposed? *

NoYes

If yes, please provide details *

I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render refusal of this application. *

YesNo

Please advise us of anything further you feel we need to know about your property

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