Public and Products Liability proposal
This form captures everything needed to consider your public and products liability risk. Your answers save in this browser as you go, so you can stop and come back.
Before you begin
Important information
Completing this proposal form
- References to "you" or "your" mean the proposer. References to "we", "us" or "the insurer" mean the insurer or insurers who consider or underwrite this insurance. Protect Underwriting Pty Ltd (ABN 21 095 612 276, AFSL 241055) is an underwriting agency and acts for the insurer, not for you. The insurer will be identified in any quotation or policy schedule issued to you.
- Please answer all questions giving full and complete answers. If a question does not apply, mark it "Not applicable".
- If the space provided is insufficient, attach a separate signed and dated sheet giving the complete answer.
- It is your duty to provide all information requested in this form and to disclose relevant facts. A relevant fact is one that may influence the insurer's evaluation of the risk. If you are unsure what is relevant, speak to your broker.
Your duty of disclosure
This insurance is arranged for business purposes, so the duty to take reasonable care not to make a misrepresentation under section 21 of the Insurance Contracts Act 1984 (Cth) applies. This notice is given under section 22.
Before you enter into an insurance contract, you have a duty to tell us anything that you know, or could reasonably be expected to know, may affect our decision to insure you and on what terms. You have this duty until we agree to insure you. You have the same duty before you renew, extend, vary or reinstate an insurance contract.
You do not need to tell us anything that reduces the risk we insure you for, is common knowledge, we know or should know as an insurer, or we waive your duty to tell us about.
If you do not tell us something. If you do not tell us anything you are required to, we may cancel your contract or reduce the amount we will pay you if you make a claim, or both. If your failure to tell us is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed.
Before you begin
Privacy statement
We handle your personal information responsibly and in accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles.
Consent
By asking us to provide you with insurance and insurance related services, you consent to the collection, use and disclosure of the personal information you provide for the purposes set out in our Privacy Policy.
How we collect your personal information
Generally we collect personal information from you or your agents. It may also be collected from our agents and service providers, other insurers and insurance reference bureaus, third parties who may claim under your policies, service providers who assist us in investigating, processing and settling claims, third parties arranging cover for a group you are part of, statutory, regulatory and law enforcement bodies, and publicly available sources.
Why we collect personal information
The information we collect enables us to assess your application, arrange and administer your insurance, and process and settle claims. If you do not provide it, we may not be able to consider your application or arrange cover.
Who we disclose it to
Your personal information may be disclosed to the insurer or insurers considering or underwriting your insurance, their agents and placing brokers, reinsurers, related companies, our advisers, and parties involved in claims assessment, processing, investigation and settlement. Where required by law we may also disclose information to government, law enforcement, dispute resolution and regulatory bodies.
Personal information about others
Where you provide personal information about others, you represent that you have made them aware that you will do so, the types of third parties it may be disclosed to, the purposes it will be used for, how they can access it and how complaints can be made. Where you provide sensitive information about others, you represent that you have obtained their consent.
Overseas disclosure
Your insurance may be underwritten or reinsured in overseas markets, including at Lloyd's and elsewhere in the United Kingdom. We also use technology and email service providers located in the United States to receive and deliver your completed proposal. Your personal information may therefore be disclosed to recipients outside Australia, including in the United Kingdom and the United States. We take reasonable steps to ensure overseas recipients handle your information consistently with the Australian Privacy Principles. Any information disclosed may only be used for the purposes described above.
How we hold and protect your information
Your answers are held in your own browser on your device while you complete this form, and are not sent to us until you submit. We do not store your completed proposal in a public database. Once submitted it is held in our secure business systems and retained only for as long as we need it for the purposes above or to meet our legal and regulatory record keeping obligations, after which it is destroyed or de-identified.
If you are using a shared or public computer, please select "Start a new proposal" when you are finished to clear your answers from this device.
Access, correction and complaints
You may request access to the personal information we hold about you, and ask us to correct it, by contacting us. Our Privacy Policy explains how to make a complaint about a breach of the Australian Privacy Principles and how we handle complaints. It is available at www.protectunderwriting.com.au.
General information
About the business
Please detail all entities to be covered, including trading names
| Name of proposer to be covered | ABN | Date established |
|---|
Not sure of an ABN? Search it at ABN Lookup.
Principal address of the proposer and any other addresses
Please describe your business activities and the products you supply
Describe what the business actually does day to day, and anything it makes, imports, sells, hires or installs.
Is cover required for discontinued products?
Products you no longer make or supply, but which are still in the market.
Do you have representation outside Australia?
General information
Turnover and people
Turnover split by major business activity or product
Where the business is conducted in more than one state, we need turnover split by state.
| Business activity or product | State | Actual, last 12 months | Estimated, next 12 months |
|---|
Percentage split of income by state, totalling 100%
Because income is generated in NSW, please answer the following. These determine whether the NSW small business stamp duty exemption applies to your policy.
7a. Is the proposer a Capital Gains Tax small business entity within the meaning of section 152-10(1AA) of the Income Tax Assessment Act 1997 (Cth)?
7b. Is the proposer a small business individual, partnership, company or trust carrying on a business with an aggregated turnover of less than $2,000,000? Aggregated turnover is your Australia wide annual turnover plus the annual turnover of any affiliated or connected entities.
Wages
Number of employees
General information
Labour hire and contractors
Does the insured engage, or intend to engage, labour hire personnel?
From labour hire companies or internal labour hire, other than the contractors covered in question 12. Internal labour hire means the hire of staff between insured entities named within this policy.
External labour hire companies
Internal labour hire
Do you only use labour hire companies appropriately licensed under the applicable labour hire legislation?
Licensing schemes operate in Queensland, Victoria, South Australia and the ACT.
Do you engage contractors or sub-contractors?
Please estimate annual payments split between the following.
Do you assume liability under contract, or give a hold harmless, other than lease liability?
General information
Products and activities
Imported and exported products
Leave blank if you neither import nor export.
| Description of product | M / I / D | Est. annual turnover | Est. annual exports | Destination of exports | Origin of imports |
|---|
M is manufacture, I is import, D is distribute.
Is work performed away from your premises?
Is welding or hot work performed by you or on your behalf?
Do you operate to AS 1674 Part 1?
Do you, or do you intend to, use, store, handle or discharge any hazardous substances?
Do you, or do you intend to, carry out any of the following activities?
Bridge construction or maintenance; demolition of buildings or structures; use of explosives; high voltage power supply; airport tarmac; aircraft hangar or any other building used for housing, storing or repairing aircraft or aircraft components; wharf or any form of ship handling or loading facility; underground mine; railway track, culvert or crossing; steelworks; power generating facility; refinery, gas producing or bulk fuel storage facility.
Do you, or do you intend to, carry out any external work above 10 metres or two storeys?
Do you have property in your care, custody or control?
Have any products been the subject of a recall notice, voluntary or mandated, in the past 10 years?
Previous history and claims
History and claims
Have you previously held insurance for any of the covers proposed?
| Name of insurer | Policy number | Expiry date |
|---|
For any of the covers proposed, has any insurer declined, cancelled or refused any proposal or renewal, or imposed special terms or conditions?
Within the last 10 years, have you had any claims made against you, or do you know of any incidents which may lead to a claim, for any of the covers proposed?
| Date | Details | Paid | Outstanding |
|---|
Schedule of properties
Schedule of properties
List every property occupied or owned by the entities to be covered. Leave blank if the business occupies no premises.
| Insured entity | Address of property | Type of property | Occupancy or tenancy | Annual rental income | Building value |
|---|
Type of property, for example office, factory or warehouse.
Insurance required
The cover you want
What limit of indemnity do you require?
$20,000,000 is the limit most Australian businesses hold, and many commercial contracts, leases and tender conditions require it. That is a statement of market practice, not a recommendation. Please check what your own contracts require. We cannot advise which limit is right for your business.
What excess would you prefer?
An excess will apply to every policy. The minimum excess generally starts between $2,500 and $5,000 depending on the size and nature of the business. Selecting a higher excess may reduce your premium.
When do you need cover to start?
The period of insurance is 12 months from the inception date.
Almost there
Check your answers
Please check everything below before you sign. Use the change links to go back to any answer.
Declaration
This declaration must be completed and signed by or on behalf of all persons making the application for insurance. I declare that:
- I am authorised by each of the persons making the application for insurance to complete and sign this proposal form.
- After making inquiries, all facts, information and statements given in this proposal form and any supporting documents attached or otherwise supplied (the representations) are true, correct, accurate and complete.
- No material representations have been omitted, misstated, withheld or suppressed which may affect the decision to accept the application for insurance, or the terms and conditions on which any insurance is offered or provided.
- Should there be any change to the representations after they have been provided to the insurer, I will immediately inform the insurer about those changes before the relevant policy is entered into.
- I understand the insurer relies on the representations in forming its decision to offer any policy, and that except where otherwise indicated the insurer will treat the representations as being made by all persons to be insured.
- I understand that no insurance is in place until the insurer has confirmed acceptance of the application, and that if accepted, the cover will be subject to the terms, conditions and exclusions of the policy.
- I consent to the insurer collecting, using, holding and disclosing personal information in accordance with the privacy statement in this proposal form, and that where I have provided or will provide information about any other individual, I am authorised to disclose that individual's personal information and to give the above consent on both my and their behalf.
- I acknowledge receipt of the important information contained in this proposal form and that I have read and understood it.
Your typed name is accepted as your signature under section 10 of the Electronic Transactions Act 1999 (Cth). It will be recorded with the date and time in Sydney.
Thank you
Your proposal has been sent to Protect Underwriting.
Keep a copy (optional)
You do not need to send us anything else. These are for your own records.
Nothing in this form confirms cover. Cover is confirmed only by a written policy schedule.