Builders Machinery and Plant Insurance Quote

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Builders Machinery and Plant Insurance Quote

First Name:

Last Name:

Phone:

Fax:

Email:

Street Address:

Suburb:

Post Code:

State:

Site Address same as Postal Address:

Site Street Address:

Site Suburb:

Site Post code:

Site State:

Insurance Start Date:

Insurance End Date:

Turnover ($):

Are Dry Hire out machines used?:

If Dry Hire out machines were used, mention the fees for hire:

Please type N/A, if not applicable

Subcontractors used:

If subcontractors were used, mention the nature of work:

Please type N/A, if not applicable

If subcontractors were used, mention the percentage of work:

Please type N/A, if not applicable

Legal liability required:

Description of work and activities you undertake:

Please type N/A, if not applicable

Full description of activities machine is used for:

Please type N/A, if not applicable

Details of ALL claims in last 4 years::

Please type N/A, if not applicable

Details of any machinery or vehicle operators convicted of a criminal offence:

Please type N/A, if not applicable

Details of vehicle, if any
Please list the Year/Make/Model,Security Devices,Serial Number / Rego and Sum insured for each vehicle:

Help us help you by answering this survey question:
What type of roof do you have?:

Prior to entering into a contract of general insurance you have a duty to disclose certain information. You have the same duty to disclose prior to renewing, extending or varying a general insurance contract. When answering the questions you must be honest and you have a duty under law to tell us anything known to you. You, and of which a reasonable person in the known circumstances would include in answer to the questions. We use the answers in deciding whether to insure you and on what terms. If you do not answer the questions in this way, we may reduce or refuse to pay a claim, or cancel the policy. If you answer questions fraudulently, we may refuse to pay a claim and treat the policy as never have been valid.

Declaration:

I / We confirm we have read the Duty of Disclosure included in this application form and confirm the answers are true correct and that no information has been withheld which may affect the decision to accept this application or the terms and conditions.

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