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Renewal Declaration NSW
Do you require your insurance to be renewed?
Yes, I need to renew my insurance.
No, I no longer require the insurance
Company or trading name
Over the next 12 months my Turnover will be
Under $2 million
Over $2 Million
Estimated Turnover For The Next 12 Months
Please note an increased turnover will generally increase the premium.
Do your sub-contractors have their own Public Liability Insurance
Yes, they have their own Public Liability Insurance
No, they do not have their own Public Liability Insurance
I do not engage sub-contracators
Estimated Payments to Sub-Contractors For The Next 12 Months
Number of employees (including yourself)
Have your or do you expect your occupational activities to change from the occupation description noted in your current insurance schedule and/or have you changed your business name or structure with ASIC?
My business remain unchanged
My business has changed or is expected to change
Please explain the changes
Do you undertake any work on, or operate a business that is/has: Labour Hire, a refinery, chemical plant, petrol oil or gas production facilities or pipelines, offshore platforms, oil rigs, utilities, pipelines, power station, silo's, water treatment plants, railways or railway infrastructure, airport, underground work, dams, above or below ground mine sites, trains, watercraft or any other marine or maritime exposure, aircraft, scaffolding, asbestos removal, pest control, nightclub, bar, pub, demolition, tree lopping, civil construction, cranes or work on lifts
I do not work on any of these
I do work on these
What of the above do you do?
In the last 5 years have you had any criminal convictions, been bankrupt, do you have any unreported claims or incidences that you may claim against, had any insurance declined or variations imposed or anything else that may affect your insurance that we should disclose to the underwriters?
Do you require quotes or further information on these insurance products?
Management Liability (OH&S, Fairwork, ATO, ACCC & ASIC Investigation and legal costs cover)
Home & Contents Insurance
Life or Income Protection Insurance
Cyber Liability (Cover against hacking and being held to ransom by Cyber criminals)
Other (Please describe Below)
Additional Quotes Not Required
Amount of tools cover required
We offer finance broking as one of our services. Do you require pricing on any loans or finance?
What type of finance do you require?
Truck and Commercial Vehicle Finance
Boat or Jet Ski Finance
Caravan, Camper, Motorhome or RV Finance
I Require Other Finance That Is Not Listed
I hereby declare that I am a Capital Gains Tax small business entity (within the meaning of section 152-10 (1AA) of the Income Tax Assessment Act 1997 of the Commonwealth). I am a small business individual/partnership/company and/or trust, which is carrying on business, and the business has an aggregated turnover of less than $2 million.*
I earn under $2 million p.a. and qualify to have my stamp duty removed
I do not qualify for this exemption