Business Insurance

A business takes years to build – but an accident or disaster could destroy it all in minutes. That’s why businesses should help protect themselves with a quality business insurance pack.

Policy details
Policy period
From*
MM slash DD slash YYYY
To*
MM slash DD slash YYYY
Who are you insured with*
Insured details
Insured name*
First Last
Email*
Phone
Contact name*
Address*
Street Address Address Line 2 City State Postcode Country
CLAIMS HISTORY
Claims details (Within past 5 years)
Have you during the past 5 years had any insurance declined or any underwriting conditions or excesses imposed?*
- Yes
- No
Details*
Have you had any claims in the past 5 years?*
- Yes
- No
Claim Details*
Type of claim Amount
SITUATION
Situation Adreess*
Street Address Address Line 2 City State Postcode Country
Building Information
Type of building*
Year Built*
Walls*
If other, please specify*
Roof*
If other, please specify*
Floor*
If other, please specify*
RISKS
Coverage details
Building sum insured*
Contents & Stock Sum Insured
Theft of Money
Do you need cover for Glass*
- Yes
- No
Liability Sum Insured*
Business Interruption / Loss of income
Signature
This electronic signature will be treated the same as if signed personally.*
This is signature..
Name

Business Insurance

Business Insurance

Policy details

Policy period

Insured details

CLAIMS HISTORY

SITUATION

Building Information

RISKS

Signature

Insurance Quote

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Fully Insured Pty Ltd

Type of claim	Amount