About Your Business
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Business Description:
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Business Address:
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ABN:
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About Your Property
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Construction:
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Walls:
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Roof:
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Floor:
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Fire Protection:
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Security:
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About Your Insurance Needs
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Please enter sums insured required for the following cover types. Values are to be given without dollar signs and commas (for e.g. $10,000,000 is to be entered in as 10000000). Type zero '0' if cover is not required.
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Fire Cover:
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Burglary Cover:
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Liability Cover:
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Public Liability:
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Products Liability:
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Business Turnover:
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$
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No. of Employees:
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Other Covers:
Select from the following list other insurance cover(s) required:
(Tick if Required)
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General
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Is this business currently insured?
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(Tick for Yes)
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If Yes, who is the current insurer?
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What is the expiry date of the policy?
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(dd/mm/yyyy)
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Was the policy arranged by an insurance broker?
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(Tick for Yes)
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If Yes, name of broker:
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Comments:
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