Commercial Insurance Quote Your Name*Email Address Contact Telephone*Business Name*Address* Street Address Suburb Post Code ConstructionWallsBrick/ConcreteTimber/FibroOtherRoofTiledIronConcreteFloors GroundConcreteTimberFloors AboveTimberConcreteNot ApplicableNumber of Floors123Property OwnerYesNoYear BuiltFire ProtectionSprinklerYesNoFire ExtinguisherYesNoFire BlanketsYesNoSmoke AlarmsYesNoHose ReelsYesNoHydrantsYesNoSecurityDeadlocks all External Doors excluding Fire ExitsYesNoAre Ground Floor Windows fitted with security bars or key locks?YesNoSecurity PatrolYesNoRam Raid BarriersYesNoPadlocks on Roller DoorsYesNoSecurity LightingYesNoBurgular Alarm*YesNoTypeLocalBack to BaseDallerSecuritelAlarm Monitored by whomOther InformationAdjoining PremisesClaims History Last 5 Years - Include History of PrincipalsNo. of years in business at this locationElsewhereTrading Hours/DaysPublic/Product LiabilityNumber of EmployeesNumber of PrincipalsEstimated Annual Wages $Annual Turnover $Details of ProductDeep Frying Cooking on Premises?yesnoNo. of FryersLitre CapacityMaterial Loss & DamagePlease list the Replacement Value for your Assetts belowBuildingsContents (non stock)StockLoss of RentRemoval of DebrisOtherBusiness InterruptionGross Annual RevenueWages not includedAdditional Increased Cost of WorkingOutstanding AccountsIndemnity Period (months)OtherBurglaryStock - ex. Tobacco/LiquorStock - Tobacco/LiquorContentsElectronic EquipmentOtherMoneyIn TransitIn Premises - Business HoursIn Premises - After HoursIn Safe/StrongroomIn Private ResidenceGlassFrontage (e.g. Single, Double, Multi)Internal (Yes or No)ExternalIlluminated Signs (Yes or No)Broadform LiabilitySum Insured - Public LiabilitySum Insured - Products LiabilityWhat is 10 + 8 ? (answer correctly to submit the form)Spam SecurityAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country CommentsThis field is for validation purposes and should be left unchanged.
