|
Maximum Construction Period
|
6 months 12 months 18 months |
|
Basis of Cover
|
Run-off Transfer |
|
State
|
NSW VIC QLD NT SA TAS WA ACT |
|
Postcode
|
|
|
have you ever had insurance cancelled or declined?
|
no yes |
|
details of any claims in last 5
years
|
|
|
any work in, over or under water?
|
no yes |
|
any contracts where a swimming pool
comprises over 30% of total?
|
no yes |
|
any work involving: explosives,
demolition, underpinning, piling, lowering water table, or excavation deeper than 3m ?
|
no yes |
|
any work north of 26th parallel?
|
no yes |
|
indicate the % of your total
turnover that is from :
|
Residential Building Construction % |
|
|
Commercial Building Construction % |
|
|
Residential Alterations & Additions % |
|
|
Commercial Alterations & Additions % |
|
Maximum Contract Value
|
$ |
|
Estimated Turnover
|
$ |
|
Public Liability Limit
|
$5,000,000 $10,000,000 $20,000,000 |
|
Excess Option
|
$500 $1,000 $2,500 $5,000 |
|
Please provide details of any other
cover required
|
|
|
Comments and/or additional
information
|
|
|
Your current insurance renewal date
(or when your require cover to start)
|
// (dd/mm/yyyy) |
|
How did you hear about us?
|
referred by : |
|
|
I’m an existing customer of Allrisk Pty Ltd |
|
|
Yellow Pages, White Pages, Google |
|
|
Linked from website : |
|
|
other : |