1
Quote Details
2
Risk Information
3
Optional Covers
4
Contact Details
*
Represents a mandatory field.
Insured Details
*
Insured
*
Start Date
Format: DD/MM/YYYY
*
End Date
Format: DD/MM/YYYY
Risk
*
Association or Affinity Member
-- Please select an option --
AGPAL
AAPM
ADA
ADAQ
APNA
ADHA
Div of General Practice
Other
*
Please specify
*
Nature of Business
-- Please select an option --
Health
Health Association / College
Medical
Dental
Veterinary
Other
*
Please specify
For additional locations, click the add button below.
If there are more than 3 additional locations then you will need to
Contact Us
Main Premises
*
Address
*
Suburb
*
Post Code
*
State
Construction Details
*
Walls
-- Please select an option --
Brick
Iron
Concrete
Other
*
Please specify
*
Roof
-- Please select an option --
Concrete on steel
Iron on steel
Iron on timber
Iron on other
Tile on steel
Tile on other
Other
*
Please specify
*
Floor
-- Please select an option --
Concrete
Other
*
Please specify
*
Construction Year
-- Please select an option --
1980 or later
Prior to 1980
*
Fire Protection
-- Please select an option --
Sprinklers
Automatic fire alarms
Sprinklers and automatic fire alarms
No sprinklers or alarms
*
Security Company Monitored Alarm
Yes
No
*
Deadlocks on External Doors
Yes
No
*
Key Locks on Opening Ground Level Windows
Yes
No
*
Do you occupy and trade from this location for
More than 20 hours a week
Less than 20 hours a week