Organisation Information

Your Business

Yes

Are you a religious / worship group based in Australia?

Please describe percentage split of your activities you wish to be noted on the policy as the business description (e.g. Religious organisation including fundraising, social welfare camps, childcare, school etc)

Total must be 100%: 0%

If your income is earned in only 1 state, please enter 100 in the corresponding box below. If your income is earned in multiple states, please provide an approximate % breakdown of Annual Income for each state in the boxes below.

Total must be 100%:

NSW

ACT

QLD

VIC

TAS

Overseas

Yes

Can you provide a letter from your State Revenue Office confirming you are exempt from all Stamp Duty charges?

Please send us your stamp duty letter upon completion of this questionnaire.
This question does not relate to Tax Exemption.

Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?

Yes No

Yes

Do you require Building and/or Contents Insurance?
Please disclose all locations where you conduct your business activites and require building and/or contents insurance.

Property

Do you require Flood coverage?

It is imperative that you insure your building and contents for the full insurance replacement value to avoid yourself being out of pocket by a substantial amount in the event of a loss.

The insurance replacement value is the cost to replace the building as new which includes removal of debris, architects' / engineers' fees, council requirements etc.

Yes

Is there any location which is currently or may be vacant for 30 days or more in a row?

Please explain why, plan for future use and current frequency of checks on the premises.

Do you hire your premises to third parties for use?

Do you check to ensure third party users of your premises have a valid public liability insurance certificate of at least $10 million limit of liability?

Does your premises have cooking facilities which includes deep frying?

Are you aware of any existing damage to your declared building and/or contents?

please provide details.

Does any landlord, government statutory authority or government department require to be indemnified under your Industrial Special Risk policy? e.g. Interested Party such as Council, Financer

Enter Full Name of the Indemnified Party which will appear as a Interested Party on your Certificate of Currency: