03 9425 1346 www.edgewise.com.au email us

03 9425 1346 www.edgewise.com.au

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Click Submit on the last page and we will review your submission before sending to insurer/s for quotation
Once we receive a quotation from the insurer/s we will provide you an email with the complete quotation details for review and acceptance
Once the quotation is accepted by email response, we will provide an invoice for payment
A Certificate of Insurance will be issued upon receipt of payment

How did you find us?

Please provide details:

Primary contact details for all correspondence

First Name

Last Name

Contact Phone Number

Email address

Re-enter Email address

Yes

Are you currently insured

Expiry Date

Name of current insurer

Name of Broker (if applicable)

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

Insured Details

Registered Organisation Name(s):

Date of commencement of first operations

Please refer to ACNC Search and provide the relevant link if available:

Website

Primary address details

Street Number/ Name:

(select this check box if address is not listed)

Suburb:

State:

Postcode:

Are you Registered for GST ?

Yes No

ABN

Period of Insurance

Policy Start Date: The policy starts from either the date of payment or future date advised following payment