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95 Stirling Hwy, Nedlands WA 6009
1300 438 268
info@contractorcover.com.au
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Get a Quote
1
Choose your Insurance
package
2
Personal Details
3
Insurance Cover
Details
4
Review
Choose your Insurance package
You can select multiple contracts.
Choose your Insurance package/s
(Required)
Public Liability Insurance
General Property Tools Cover
Workers Compensation
Personal Accident Insurance
Professional Indemnity
Other
Personal Details
First Name
(Required)
Last Name
(Required)
Trade
(Required)
Trade
Agriculture and Farming
Architectural and Engineering
Beauty and Grooming
Cleaning Services
Construction Trades
Education and Training
Electrical and Installation Services
Event and Performance
Financial and Accounting Services
Health and Therapy Professions
Hospitality and Food Services
IT and Consulting
Landscaping and Gardening
Legal Services
Maintenance Services
Manufacturing and Production
Marketing and Media
Pet Grooming Services
Real Estate and Property
Recruitment and HR
Retail and Sales
Transportation and Logistics
Other
ABN
(Required)
Please list the trade you work in, e.g. mining, electrician.
(Required)
Entity/Company Name
(Required)
Date
(Required)
MM slash DD slash YYYY
Email
(Required)
Phone Number
(Required)
Street Address
(Required)
Suburb
(Required)
State
State
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Post Code
(Required)
Public Liability Insurance Cover
Public and Product Liability Limit
(Required)
$5 000 000
$10 000 000
$20 000 000
more then $20 000 000
Number of Direct Employees
(Required)
Estimated Annual Turnover (in dollars)
(Required)
Do you engage contractors/subcontractors?
(Required)
Yes
No
Estimated Payment to Subcontractors (in dollars)
General Information and Disclosure
Select if you conduct work at or in connection with:
(Required)
Select an option
Mine sites
Elevators Escalators Travelators
Tower Cranes or Derrick Cranes
Asbestos Removal
Medical/Hospital Facilities
High voltage power lines
Operate the business outside of Australia
Public Utilities
Bridges or dams
Use of the explosives
Handle hazardous substances
Ship or Marine Risk
None of the above
Do you engage in any of the following activities?
(Required)
Select an option
Working on heights over 10 meter
Work under 3 meters in depth
Commercial work
Driving Risk
Designed contracts and Hold Harmless agreements
Perform hot works away from premises
Hire out equipment or staff
None of the above
Select if you or any partner(s) or director(s) of the business have
(Required)
Select an option
Insurance policy cancelled or declined
Ever been declared bankrupt
Been insolvent or in voluntary administration
Been convicted of any criminal offence
Been liable for any civil offence or pecuniary penalty
Special Conditions Imposed on the policy
Have you had any Public Liability claims in the last 5 years?
None of the above
If yes to any of the above questions please provide full details below
Other relevant Information you wish to disclose
Personal Accident Insurance
What type of personal accident cover would you like?
(Required)
Personal Accident Only
Personal Accident & Illness
What weekly benefit amount would you like to insure?
(Required)
What level of cover for accidental death & disability would you like?
(Required)
I do not want this cover
$50 000
$100 000
$200 000
Have you had any previous claims for Personal Accident and/or Illness?
(Required)
Yes
No
Do you have any pre-exisisting medical conditions?
(Required)
Yes
No
If you have answered yes to either of the above please provide full details below
General Property Tools Insurance Cover
Sum insured of all your tools of trade?
(Required)
Do you have any items valued at more than $2,500 per item?
(Required)
Yes
No
If so, please list the Item name, make, model & sum insured
Have you had any General Property Insurance claims in the last 5 years?
(Required)
Yes
No
If yes, please provide full details below
Other relevant information you wish to disclose
Workers Compensation
We can only offer Workers Compensation insurance in WA, NT and ACT due to licensing restrictions.
Do you have existing Workers Compensation Insurance?
(Required)
Yes
No
Please select your current insurer
Allianz
CGU
GIO
QBE
Zurich
Expiry date of current policy?
DD slash MM slash YYYY
Total estimated wages paid to direct employees in the next 12 months (not including working directors or subcontractors)
(Required)
Do you require cover for working directors?
(Required)
Yes
No
If yes, please list all working directors full names and their individual wages
Have you had any Workers Compensation insurance claims in the last 5 years?
(Required)
Yes
No
If yes, please provide full details below
Do you engage contractors/subcontractors
(Required)
Yes
No
Estimated Wages (in dollars) - Labour Only
Estimated Wages (in dollars) - Labour & Tools
Estimated Wages (in dollars) - Labour & Plant
Estimated Wages (in dollars) - Labour & Materials
Estimated Wages (in dollars) - Labour, Plant & Materials
Other relevant information you wish to disclose
Professional Indemnity
Please describe in detail your business activities?
(Required)
What are your qualifications and years of experience?
(Required)
Do you charge a separate fee for your designs or advice?
(Required)
Yes
No
If yes, please provide further details
Total number of staff providing advice?
(Required)
Estimated Annual Turnover (in dollars)
(Required)
Total fees for design and advice (in dollars)
(Required)
Professional Indemnity Limit
(Required)
$500,000
$1,000,000
$2,000,000
$5,000,000
$10,000,000
Do you currently have Professional Indemnity Insurance?
(Required)
Yes
No
If yes, please provide the name of your current insurer
What is the renewal date of your policy?
DD slash MM slash YYYY
What is the retroactive date of the policy?
DD slash MM slash YYYY
Duty Of Disclosure
Please select any of the below if relevant to you and your business
(Required)
Select an option
Ever been subject to disciplinary proceedings for professional misconduct
Have any claims for negligence or breach of professional duty been made in the last ten years
AFTER INQUIRY aware of any claim or circumstance that might give rise to a claim
Any accounts overdue for payment where there is reason to believe that the client is dissatisfied with the professional services
Had professional indemnity insurance during the past three (3) year
Ever had this type of insurance refused (including renewal) cancelled avoided or an application or proposal declined or had special terms imposed
None of the above
Select if you or any partner(s) or director(s) of the business have
(Required)
Select an option
Insurance policy cancelled or declined
Ever been declared bankrupt
Been insolvent or in voluntary administration
Been convicted of any criminal offence
Been liable for any civil offence or pecuniary penalty
Special Conditions Imposed on the policy
Have you had any Public Liability claims in the last 5 years?
None of the above
If yes to any of the above questions please provide full details below
Other relevant information you wish to disclose
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