Business Insurance

AUSURE Business Insurance Quote Request

Our brokers will review the details you provide, identify several options from different Australian Business Insurance companies and forward policy options to you for your consideration. Fields marked with * are mandatory. If only the required fields are completed a broker will be in contact with you regarding the particulars, if you complete the full form a broker will quote your policy and contact you with prices.

Insured Details
Business Name:
Trading Name:
ABN (if applicable):
ACN (if applicable):
Business Address:
Trade Business Type:
Estimated Annual Turnover:
Period of Insurance
From:	Date and time
To:	Date and time
Insurance History
In the last 5 years have you had any?:	AccidentsLicence SuspensionCriminal ConvictionsClaims
If you have answered yes to any of the above questions, please provide details here:
Building Details
Sums Insured
Building Value:
Stock Value:
Other Content:
Burglary Theft Stock:
Tobacco Cigarettes:
All Other Contents:
Cash:
General Property:	YesNo
Details
Age of Building:
How many Stories is the Building?:
Building SQM:
Walls:
Townwater:
Roof:
Floors:
Flammables:
Dangerous Goods:
Welding:
Adjoining Properties:	LeftRightRearOther
Smoke Detectors:
Fire Protection Single Sprinklers:	YesNo
Fire Protection Dual Sprinklers:	YesNo
Fire Protection Extinguishes:	YesNo
Fire Protection Hydrant Hoses:	YesNo
Building Security
Alarm:
Deadlocks:
Roller Door:
Window Bars:	YesNo
Window Grills:	YesNo
Window Shutters:	YesNo
Windows Keyed Locks:	YesNo
Description of Property to be covered:
Are you aware of any matters not disclosed above that is relevant to the underwriters consideration of this insurance, if so please provide details:	Please provide details, or enter NONE
Fire Cover
If you would like fire cover please complete the below questions, otherwise please skip to Business Interruption
Is Fire Cover required:
Please enter the sum insured required for the situation
Building:
Plant and Contents:
Electronics:
Stock:
Accidental Damage:
Other:
Seasonal Increase %:
Voluntary Excess:
Business Interruption
If you would like Business Interruption cover please complete the below questions, otherwise please skip to Glass Section
Business Interruption Cover:
Indemnity Period (Weeks):
Gross Profit/ Revenue ($):
Loss of Rent ($):
Additional Increased Cost ($):
Claims Preparation Cost ($):
Book Debts/ Accountant Fees:
Customer / Supplier Premises:	CustomerSupplier
Please provide details if you have ticked either of the above:
Voluntary Excess:
Other Details:
Glass Cover
Is glass cover required:
Required for:	InternalExternal
Burglary
Is Burglary cover required:
If you answered no to the above question, please skip to Money cover, if you have answers yes please complete the sums insured below
Please enter the sum insured required for the situation
Contents:
Stock:
Combined Contents and Stock:
Computers and Electronic:
Cigarettes and Tabacco:
Other:
Theft in Open Air:
Damage by Burglars:
Employees Property:
Seasonal Increase %:
Voluntary Excess:
Other details:
Money
Is Money Cover required:
If you answered no to the above question, please skip to Liability, if you have answers yes please complete the sums insured below
In Transit:
During Business Hours:
Outside Business Hours:
In private residence:
In locked safe:
Damage to Safe:
Seasonal Increase %:
Voluntary Excess:
Other Details:
Liability
Is Liability cover required:
If you have answered no to the above question, please skip to Employee Dishonesty section
Public Liability:
Products Liability:
Other:
Please provide details of Other:
Goods in care custody & control:
Description of Goods:
Activites:	Please provide description of activities to be covered by this section
Products:	Please provide details of Products Manufactured, Hired or Sold
Do you require indemnity cover for overseas operations:
Import Details:	Please provide details of Imports
Export Details:	Please provide details of Exports
Annual Turnover:
Wages ($):
Number of Staff:
Number of Working proprietors:
Subcontractors:	Please provide details of Subcontractors, otherwise please type NONE
Extensions Required:	Road Testing Unregistered Vehicles Hold Harmless Agreement Pressure Vessels Asbestos Exposure Watercraft Aircraft Treatment Risk Other
Please provide details if 'Other' selected above:
Employee Dishonesty
Is Employee Dishonesty cover required:
If you have answered no to the above question please skip to Machinery Breakdown
Limit of Indemnity
Any one employee ($):
Any one period of insurance ($):
Please advise the number of:
Directors/ Executives:
Employees responsible for money:
Employees responsible for stock:
Employees in outdoor sales & delivery:
Employees paid by commission:
All other employees:
Is cover required for:
Agency Personnell:
Loss by inidentified employees:
Supperannuation funds:
Welfare, Social, Sports club:
Please advise if:
Monies banked daily:
Outdoor sales, deliveries, collections accounted weekly:
Statements sent direct to customers:
Cash books, receipts, bank statements independantly checked monthly:
Petty Cash & Wages records independantly checked each month:
Wages prepared & checked by a different person:
Cheques require two signatures:
Stock indepentantly checked regulary:
Details:	If you have answered NO to any of the above please provide details
Machinery Breakdown
Is Machinery Breakdown required?:
If you have answered NO to the above question please skip to Computer/Electronic Equipment
Sums Insured
Machinery Breakdown:
Pressure Vessel Explosion:
Deterioriation of Stock:
Increased cost of working:
Indemnity Period (Months):
Please provide details of items to be specified on the policy and sums insured
Specified Items	Sums Insured





Blanket Cover Schedule Sums Insured
Machine Description	Quantity
Refrigeration Units up to 4HP/3KW:
Airconditioning Units up to 4HP/3KW:
Electronic cash register:
Microwave Oven:
Roof Mounted Evaporative Air Coolers:
Dishwasher:
Clothes Washing Machine:
Glasswasher:
Ice Machine:
Clothes Dryers & Extractors:
Electronic Scales:
Refrigeration units over 4HP/3KW:
Pressure Vessel:
Boilers:
Is this equipment:
Regulary Serviced:
Owned:
Registered (Pressure Vessels):
More than 20 years old:
Modified from manufacturers specification:
Computer / Electronic Equipment
Is Computer/ Electronic Equipment required:
If you have answered no to the above, please skip to General Property
Type of cover:
Section A: Material Damage
Item List	Sum Insured






Portable / movable Equipment (including laptops)
Items List	Sum Insured






Section B: Business Interruption
Items List	Sum Insured
Increased cost of working:
Gross Income:
Uninsured working expenses:
Reinstatement of data:
Voluntary Excess:
Other Details:
General Property
Is general property cover required:
If you have answered no to the above question please skip to Goods in Transit
Type of cover:
Unspecified tools of trade (excluding Mobile phones):
Limit any one item ($):
Items List	Sum Insured





Voluntary Excess:
Other Details:
Goods in Transit
Is Goods in Transit cover required:
If you have answered no to the above question please skip to Other requirements
Type of Cover:
Items List	Sum Insured





Geographical Limits:	State wideAustralia wideWorld wideOther
If you have selected 'Other' above, please provide details::
Voluntary Excess:
Other Details:
Other requirements
Is Workers Compensation / Personal Accident cover required:
Is Motor Vehicle insurance required:

Contact Details
First Name*:
Last Name*:
Date of Birth*:	Date and time
Phone with Area Code*:
Mobile Phone*:
Email Address*:
Postcode*:

Business Insurance

AUSURE Business Insurance Quote Request

Insured Details

Period of Insurance

Insurance History

Building Details

Building Security

Fire Cover

Business Interruption

Glass Cover

Burglary

Money

Liability

Employee Dishonesty

Machinery Breakdown

Computer / Electronic Equipment

General Property

Goods in Transit

Other requirements

Contact Details