"*" indicates required fields Step 1 of 3 33% Your DetailsName* First Last Address* Street Address Suburb State Postal Code Contact Number*Email* Period of InsuranceStart Date* DD slash MM slash YYYY Expiry Date* DD slash MM slash YYYY Insured Name* First Last ABN Trading Name Business Occupation Location of Risk* Any claims in the last 3 years?*SelectYesNoClaim Details:*Date of Incident: (DD/MM/YYYY)Description of Incident:Claim Settlement Amount ($) : Add RemoveEquipment ListingSpecified Items*Description:Serial Number:Sum Insured ($) : Add RemoveDo you require cover for Unspecified Items?*SelectYesNoTotal Sum Insured:* Note: Unspecified Items are covered up to $3,000 per item. Any items valued above $3,000 will need to be specified above.Consent* I agreeNon Disclosure: If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce its liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning. In addition to the above, following documents can be viewed on our website: PRIVACY POLICY: https://www.imcinsurance.com.au/privacy/ FINANCIAL SERVICES GUIDE (FSG): https://www.imcinsurance.com.au/financial-services-guide/ CONTACT US: IMC Insurance Brokers Pty Ltd | ABN 79 676 680 946 | AFSL 229344 Level 1 251-253 Malvern Road, South Yarra, VIC 3141 | 1300 251 253 | insure@imcinsurance.com.au Δ