Tradie Protection

Main Contact – Name(s)

Email Address

Phone Number

Postal Address

Entity or Sole Trader Name

Australian Business Number (ABN)

Director(s) Name(s)

Gross Turnover by Region and Financial Year

Please include all turnover/revenue from all activities.

Region	Last Financial Year	Current Financial Year	Coming Financial Year
Australia / New Zealand
USA / Canada
Elsewhere
Total

Income Percentage by State (must total 100%)

NSW	VIC	QLD	SA	WA	TAS	NT	ACT	O/S	Total

Do you handle Dangerous Goods
YesNoUnsure

Do you handle Asbestos?
YesNo

Do you work at any of the following:

Drag Line Excavators
Highvoltage Power Supply Areas
Airport Tarmacs and Aircraft Hangars
Wharves and Ship Handling Facilities
Underground Mines
Railway Tracks and Related Infrastructure
Steelworks

YesNo

Doe you Perform any Welding?
YesNo

Do you work over 10m in height?
YesNo

Do you dig more than 2m in depth?
YesNo

Do you Import or Export?
YesNo

Do you assume liability or contract in additional exposure?
YesNoUnsure

Do all subcontractors carry their own Public & Products Liability insurance?
YesNo

Number of Full Time Employees

Number of Part Time or Casual Employees

PUBLIC & PRODUCTS LIABILITY

Public Liability Cover
$5,000,000$10,000,000$20,000,000

Products Liability Cover
$5,000,000$10,000,000$20,000,000

TOOLS & EQUIPMENT COVER

Unspecified Tools Limit (under $3,000 per item)

Specified Tools (over $3,000)

TAX AUDIT

Do you require Tax Audit cover?
YesNo

MOTOR VEHICLE

Primary Vehicle

Description of Vehicle

Registration Number

Modifications

Accessories

Driver 1

Driver 2

Finance

Vehicle Use
Will this vehicle be used for Driver Education, Racing, Courier/Delivery, Hire Car, Taxi, Uber, Courtesy , Removalist
YesNo

Occupation

Sum Insured
You have the choice to insure the Vehicle for an Agreed value or Market Value. Please type below either the value of your vehicle or Market Value

Hire Car following an accident
YesNo

Windscreen Excess Waiver
YesNo

DUTY OF DISCLOSURE QUESTIONS

Previous Claims Declined?

Ever been liable for any civil offence or pecuniary penalty?

Ever been charged or convicted of a criminal offence?

Ever had an insurance policy cancelled, declined or terms imposed?

Aware of circumstances which could give rise to a claim?

Anything to Declare under Duty of Disclosure?

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Tradie Protection

Primary Vehicle

Second Vehicle

Third Vehicle

Fourth Vehicle

Our Information