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Business & Office Quote

Your Details

Full name: (incl Title) *

Contact telephone number: *

Date of Birth: *

Email address: *

Contacting You

Preferred contact method: *

Preferred contact time: *

How did you hear about us? *

Business Details

Name of business: (legal entity)

Business address:

State

Postcode:

Business type:

Duty of Disclosure

Ever had any insurance cancelled or declined or special terms imposed?

YesNo

Ever been charged or convicted of any criminal offence or declared bankrupt?

YesNo

Insurance Requirements

Section 1: Fire & Perils – Property

Cover: Insures your assets against loss or damage caused by insured peril including fire, lightning, thunderbolt, explosion, earthquake, impact, wind, storm and water (excluding flood), malicious damage and accidental damage. (Please refer to your policy disclosure statement on the inception of your policy)

Buildings:

Contents:

Stock:

Removal of Debris:

Accidental Damage:

Other (Please specify):

Section 2: Business Interruption

Cover: Insures the risk of reduction in or loss of gross income as a result of an insured loss or damage to your policy.

Gross Annual Income: (Money payable to you less the purchase cost of stock):

Additional Increased Cost of Working:

Claims Preparation Costs:

Loss of Rent:

Accontants Fees:

Indemnity Period:

Section 3: Theft/Burglary

Cover: Insures the risk of loss of your contents and stock from theft, attempted theft (following forced entry or exit to or from the premises).

Contents:

Stock (Excluding Tobacco, Cigars, Cigarettes):

Stock (Including Tobacco, Cigars, Cigarettes):

Other (Please specify):

Section 4 – Money

Cover: Insured the risk or loss of or damage to your money from causes such as theft, armed hold up, fire whether at your premises or in transit.

In Transit:

In Building – Business Hours:

In Building – Non Business Hours:

In Locked Safe:

In Private Residence:

Damage to Safe:

Section 5 –Glass

Cover: Insures external and internal glass

External:

YesNo

Internal:

YesNo

Size:

Additional cover for signs:

YesNo

Section 6 – Liability

Public Liability:

Products Liability:

No of Employees:

Turnover:

Section 7 – Machinery & Plant

Please list items to be insured: (Please specify a value)

Deterioration of frozen stock:

Section 8 - Electronic Equipment

Computers & Word Processors:

Portable Computers:

Other (Please Specify with a value):

Business Interruption:

Restoration of Data:

Increased Cost of Working:

Section 9 – General Property

Cover: Accidental loss or damage, malicious damage or theft resulting from forcible and violent entry evidence by visable damage anywhere in Australia

Please specify items to be insured including make, model and serial numbers:

Claims Experience

Please provide full details of any claims made and/or losses suffered under previous Business Insurance during the past 5 years (whether or not a claim was made):

General Questions

Please use this box to provide any further information that may be relevant to your Business Insurance policy :

Current Business Insurance provider:

Renewal date of existing insurance/date cover to start (as applicable):

Current Business Insurance premium:

Are you an existing Gale Insurance customer? *

YesNo

Gale Insurance Brokers trading name of Gale Insurance Pty Ltd. We would like to contact you from time to time about products and services (or with news, offers and promotions) that we feel may be of interest to you. By providing us with your contact details, you consent to being contacted by these methods for these purposes.

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