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Disclaimer and terms and conditions. By submitting this quote request you agree that: I/We have read the duty of disclosure included in this Application Form. I/We confirm that the answers and statements in this application are correct and that no information has been withheld which may affect the decision to accept this application or the terms and conditions. A) intermediaries through which I/we deal with Macleay Insurance (for instance an agent, broker or financial advisor); B) claims assessment participants (for instance an assessor, investigator and/or loss adjuster); C) other reputable service providers (for instance mail houses ); and/ or D). Underwriters, who are responsible for part/all of the risk under a contract of insurance (for instance a reinsurer). I/We understand that Macleay Insurance may give to or obtain from other insurers and/or Insurance Reference Services information from this application and claims information obtained through the course of the contract. By submitting this Application Form, I/we consent to Macleay Insurance collecting and using this information for these purposes. This is subject to my/our right to opt out of receiving various direct marketing materials at any time. I/We acknowledge that I/we have rights to access my/our personal information held by Macleay Insurance in accordance with the National Privacy Principles. I/We understand that this insurance does not operate until acceptance of this application in writing by Macleay Insurance (except for any cover provided under an interim contract of insurance). Prior to personal and sensitive information being collected and any personal advice and or insurance product advice being made I/we received a copy of the FSG (available also on this website) and given the opportunity to read it before voluntarily giving my personal information. The Adviser told me/us that if I/we chose not to provide the adviser with complete and accurate information, that the adviser could only give me/us Limited Advice warning in relation to the limitations of the provision of personal advice. That the advice and recommendations given may not be accurate or truly suit my needs.

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Liability Insurance Quote

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Level of protection $

Insured Details

Insured Address

Do you/expect to hire subcontractors?

Yes, I do No, I don't

Do you expect to engage labour hire?

Yes, I do No, I don't

Does the business export any products to North America?

Yes, I do No, I don't

Current Insurer Details

In the last five (5) years, has the insured ever been placed in receivership or liquidation or declared bunkrupt?

Yes, I have No, I haven't

In the last five (5) years, have you been convicted of or had any fines or penalties imposed for any crime involving drugs, dishonesty, arson, theft, fraud or violence against any person or property?

Yes, I have No, I haven't

Have the insured ever had insurance declined or cancelled or had special terms imposed by an insurance company?

Yes, I have No, I haven't

5 year Claims History

Disclaimer and terms and conditions. By submitting this quote request you agree that: I/We have read the duty of disclosure included in this Application Form. I/We confirm that the answers and statements in this application are correct and that no information has been withheld which may affect the decision to accept this application or the terms and conditions. A) intermediaries through which I/we deal with Macleay Insurance (for instance an agent, broker or financial advisor); B) claims assessment participants (for instance an assessor, investigator and/or loss adjuster); C) other reputable service providers (for instance mail houses ); and/ or D). Underwriters, who are responsible for part/all of the risk under a contract of insurance (for instance a reinsurer). I/We understand that Macleay Insurance may give to or obtain from other insurers and/or Insurance Reference Services information from this application and claims information obtained through the course of the contract. By submitting this Application Form, I/we consent to Macleay Insurance collecting and using this information for these purposes. This is subject to my/our right to opt out of receiving various direct marketing materials at any time. I/We acknowledge that I/we have rights to access my/our personal information held by Macleay Insurance in accordance with the National Privacy Principles. I/We understand that this insurance does not operate until acceptance of this application in writing by Macleay Insurance (except for any cover provided under an interim contract of insurance). Prior to personal and sensitive information being collected and any personal advice and or insurance product advice being made I/we received a copy of the FSG (available also on this website) and given the opportunity to read it before voluntarily giving my personal information. The Adviser told me/us that if I/we chose not to provide the adviser with complete and accurate information, that the adviser could only give me/us Limited Advice warning in relation to the limitations of the provision of personal advice. That the advice and recommendations given may not be accurate or truly suit my needs.

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Building & Contents Insurance Quote

Home Contents Quote Form is for when you are occupying the premises. If you are a landlord wanting to cover a building/contents for a property you don't occupy please fill in our Landlord Quote Form

Applicant/Insured Details

Building details

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Client Referral Form

Client Contact Details

Brief info about the insurance required

The referrers Details

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Midnight Express Pokie

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