Quotation Request for Advertising Agency Office Insurance

Please complete this form to request an insurance quote from our firm. Questions marked with an * are mandatory and must be completed so a response can be provided.

If you prefer to provide the information in this form directly over the phone, please indicate this below and we will contact you promptly.

Prior to submitting this form please read the following which describes our practices in relation to the handling and use of personal information.

You have selected: Advertising Agency Office


This information gathering form is appropriate for operators of an advertising agency business. The form includes components to protect physical assets such as buildings, contents and stock as well as liability and other areas relevant to business operators.

About You
Contact Name: *
Contact Number: *
Email Address: *
Business Name: *
Tick here if you prefer to provide the information in this form directly over the phone. We will arrange for a representative to contact you promptly.

About Your Business
Business Description:
Business Address:
ABN:

About Your Property
Construction:
Walls:
Roof:
Floor:
Fire Protection:
Sprinklers:
Extinguishers:
Smoke Detectors:
Fire Blankets:
Other:
Security:
Deadlocks on all External Doors:
Bar/Grills on Windows:
Local Alarm:
Back to Base Alarm:
Other:

About Your Insurance Needs

Please enter sums insured required for the following cover types. Values are to be given without dollar signs and commas (for e.g. $10,000,000 is to be entered in as 10000000). Type zero '0' if cover is not required.
Fire Cover:
Building(s): $ 
Contents, Plant & Machinery: $ 
Stock: $ 
Other: $ 
Burglary Cover:
All Contents: $ 
Stock: $ 
Other: $ 
Liability Cover:
Public Liability:
Products Liability:
Business Turnover: $ 
No. of Employees:
Other Covers:

Select from the following list other insurance cover(s) required:
(Tick if Required)
Business Interruption / Loss of Revenue
Electronic Equipment
Employee Fraud
General Property
Glass
Goods in Transit
Machinery Breakdown
Money
Other

General
Is this business currently insured? (Tick for Yes)
If Yes, who is the current insurer?
What is the expiry date of the policy? (dd/mm/yyyy)
Was the policy arranged by an insurance broker? (Tick for Yes)
If Yes, name of broker:
Comments:
* Indicates a mandatory field.
 
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