The following sections are commonly available in a Business Insurance Package. Please select those sections which apply to you and your business and click NEXT to complete the form with as many details as possible. If you are unsure about which sections apply, please contact us for assistance. Fire & other specified perils Business Interruption Burglary Money Glass Liability Transit Electronic Computer Breakdown Machinery Breakdown General Property Tax Audit Employee Fraud Motor Vehicles Who This Enquiry Is ForFor us to provide the best response to your inquiry please complete the followingThis inquiry is for an existing business with current insuranceThis inquiry is for an existing business without insuranceThis inquiry is for a new businessContact DetailsFirst NameSurnameAddressSuburb / CityPostcodeTelephoneMobileFaxEmail Business DetailsName of the businessDescribe your businessWhat is the required start date of the insurance? Date Format: DD slash MM slash YYYY Is your business premise address different to your contact address?NoYesBusiness street addressBusiness suburb / cityBusiness postcodeDoes your business operate from multiple sites?NoYesAge of building in yearsWhat is the roof made of?TileSteelOtherWhat are the walls made of?BrickworkConcreteSteel on steelSteel on woodOtherWhat are the floors made of?TimberConcreteOtherWhat type of alarm system is installed?MonitoredLocalNoneOtherFire & other specified perilsSum Insured Building $Stock $Contents $Others (please specify)Description$ Business InterruptionIndemnity Period6 months12 monthsOther Sum Insured Gross Profit $Increased Working Cost $Wages $Rent $Other $Other DescriptionTotal $BurglarySum Insured Contents $Stock $Tobacco $Combined contents / stock $Other $Other DescriptionMoneySum Insured In Transit $On Premises $On premises outside $Business hours $In Safe $Personal custody $Other $Other DescriptionGlassSum Insured Internal or External Internal - Replacement Value External - Replacement Value Signs $LiabilitySum Insured Payout$5 Million$10 Million$20 MillionTurnover $Wages Paid $Staff Numbers $Are you the property owner?NoYesDescribe tenant's businessDo you import products?NoYesProduct 1Country of origin 1Product 2Country of origin 2Country of origin 3Product 3TransitOwn VehiclesMaximum Value per load $Annualised Total Carry $Number of Vehicles #Professional CarriersMaximum Value per load $Annualised Total Carry $Electronic Computer BreakdownDescribe equipment you wish to insureSum Insured $Machinery BreakdownSum Insured RefrigeratorAmount of unitsUnits $Air ConditionerAmount of unitsUnits $OtherAmount of unitsUnits $General PropertyDescribe equipment you wish to insure 'away from your business' (e.g. laptop computers)Sum InsuredTax AuditSum Insured $Employee FraudSum Insured $Motor VehiclesMake and modelYearRegistration NumberMain DriverDate Of Birth Date Format: DD slash MM slash YYYY The vehicle is garagedNoYesGarage postcodeNCB rating or rating numberUse Business Private Under FinanceNoYesClaims InformationPrior to the Insurer accepting any risk they will require information about any claims over the past 5 years where the claims relate to the type of insurances you wish to take out. Please describe those claims:Email a copy to me Tick for yes PhoneThis field is for validation purposes and should be left unchanged.