Commercial Insurance Quote Your Name* Email Address Contact Telephone* Business Name* Occupation Address* Street Address Suburb Post Code ConstructionWallsBrick/ConcreteTimber/FibroOtherRoofTiledIronConcreteFloors GroundConcreteTimberFloors AboveTimberConcreteNot ApplicableNumber of Floors123Property Owner Yes No Year Built Fire ProtectionSprinkler Yes No Fire Extinguisher Yes No Fire Blankets Yes No Smoke Alarms Yes No Hose Reels Yes No Hydrants Yes No SecurityDeadlocks all External Doors excluding Fire Exits Yes No Are Ground Floor Windows fitted with security bars or key locks? Yes No Security Patrol Yes No Ram Raid Barriers Yes No Padlocks on Roller Doors Yes No Security Lighting Yes No Burgular Alarm* Yes No TypeLocalBack to BaseDallerSecuritelAlarm Monitored by whom Other Information Adjoining PremisesClaims History Last 5 Years - Include History of PrincipalsNo. of years in business at this location Elsewhere Trading Hours/Days Public/Product LiabilityNumber of Employees Number of Principals Estimated Annual Wages $ Annual Turnover $ Details of Product Deep Frying Cooking on Premises? yes no No. of Fryers Litre Capacity Material Loss & DamagePlease list the Replacement Value for your Assetts belowBuildings Contents (non stock) Stock Loss of Rent Removal of Debris Other Business InterruptionGross Annual Revenue Wages not included Additional Increased Cost of Working Outstanding Accounts Indemnity Period (months) Other BurglaryStock - ex. Tobacco/Liquor Stock - Tobacco/Liquor Contents Electronic Equipment Other MoneyIn Transit In Premises - Business Hours In Premises - After Hours In Safe/Strongroom In Private Residence GlassFrontage (e.g. Single, Double, Multi) Internal (Yes or No) External Illuminated Signs (Yes or No) Broadform LiabilitySum Insured - Public Liability Sum Insured - Products Liability What 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country EmailThis field is for validation purposes and should be left unchanged. Δ
