Mining Contractors Insurance

INFORMATION REQUIRED FOR QUOTE

Current Insurer

Not insured
Insured elsewhere

Who they are insured with

Name*

First Last

Address*

Street Address Address Line 2 City State Postcode Country

Phone*

Email*

Insured Name

Type of Operation

Contractor
Exploration Company

Tell us exactly what you do:

Industry

Tenement Size

Staff Size

Anticipated Revenue/Turnover for next 12 months

Anticipated Expenditure for next 12 months

Fees/Turnover (average of the last 2 years)

ACT

NSW

NT

QLD

SA

TAS

VIC

WA

Overseas

QUESTIONS

1. Is more than 50% of your turnover derived from activities in the mining/resources industry?

Yes
No

Do you or any of your sub contractors blasting activities?

Yes
No

WEBRATER QUESTIONS

1. Is more than 50% of your turnover derived from activities in the mining/resources industry?

Yes
No

2. Do you or any of your sub contractors conduct blasting activities?

Yes
No

3. Do any of your sub contractors provide scaffolding services?

Yes
No

4. Are you a labour hire company?

Yes
No

5. Do you require cover for products?

Yes
No

6. Do you require $500K Error & Omissions cover?

Yes
No

7.If you are an Electrical Contractor are you involved in electrical supply or generation?

yes
No

8. Have you (or any person or party comprising the insured) ever made a claim or suffered a loss or had a claim declined including Worker to Worker and Subrogation claims or losses in the past 5 years?

Yes
No

9. Are you (or any person or party comprising the Insured) aware of any circumstances which may give rise to a claim?

Yes
No

10. Are you conducting any offshore manual work?

Yes
No

Anything else you wish to request or tell us?

SIGNATURE

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This is signature..

Name

Mining Contractor Insurance

INFORMATION REQUIRED FOR QUOTE

QUESTIONS

WEBRATER QUESTIONS

SIGNATURE

Insurance Quote

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