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Renewal Declaration Professional Indemnity
Do you require your insurance renewed?
Yes, I need to renew my insurance
No, I no longer require my insurance
Company or trading name
Estimated Fees For The Next 12 Months
Please note an increased turnover will generally increase the premium.
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?
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