Roasters & Cafes
Airports and Aircraft
Unmanned Aerial Vehicles (UAV)
SPRIG COFFEEPAK QUICK QUOTE
Company Or Insured Name
Situation Of Risk
New South Wales
Is this a new Business?
HoUndertake_To_Inform_The_Company_Of_Any_Material_Alteration_To_Those_Facts_Before_Completion_Of_The_Contract_Of_Insurancew long have you been in business
Less than 1 year
1 - 3 Years
3 - 5 Years
More than 5 years
Motor Vehicle / Trailer / Cart
Where is the vehicle parked / garaged?
Vehicle Age (Eg 2010)
if Rego not known, please advise either;
Vin / Chassis Number:
Any Other Modifications?
Comprehensive - Market Value or Agreed* (if less than 2 years old)
* If older than 2 years, AGREED Value requires an independent valuation
Sum insured including fit out
Current No Claim Bonus (NCB) Rating
60% - Rating 1
50% - Rating 2
40% - Rating 3
30% - Rating 4
20% - Rating 5
NIL - No Claim Bonus
(Written Proof required before cover can be granted)
Name of main driver
Age of Main Driver (DD/MM/YY)
Any interested Parties?
Interested Parties Name
Membership to Australias 365 Roadside Assistance
Provides protection against fees incurred when organising your accounts for any statutory body (EG ATO ) requesting the audit.
Public and Products Liability
Limit of indemnity - Standard Limit $20,000,000
Annual Gross Turnover
Number of Staff
Do you require Machinery Breakdown
Limit of indemnity - Standard limit $20,000
Value of Machinery value
Do you require cover for Money?
In Transit - Standard Limit $2,500
During normal Business Hours - Standard Limit $2,500
Outside normal Business Hours cover required
Contained in securely locked safe cover required
In Personal Custody - - Standard Limit $2,500
Do you require cover for General Property?
* Standard limit: $1,000 per item; $5,000 Limit.
Unspecified Items max, per item
Specified Items and value
Previous History - Must be completed
As far as known, have you or any other driver?
Had their drivers licence suspended or cancelled?
Had any convictions relating to drugs or alcohol?
Had any convictions relating to dangerous driving?
If yes to any of the above please advise
Is the vehicle owned and registered by the Insured or Company
If No please state the owner of the vehicle
Is the vehicle in a safe, roadworthy and undamaged state of repair
Has the owner of the vehicle suffered more than 3 losses, or losses totalling over $5,000
Motor Vehicle Insurer & Policy number
Declaration - Must be completed
I acknowledge that I have read and understood the Important notices contained in this application
I agree that this electronic proposal, together with any other information or document supplied shall form the basis of any contract of insurance
I acknowledge that if this application is accepted, the contract of insurance will be subject to the terms and conditions as set out in the policy wording as issued or as otherwise specifically varied in writing by the company
I declare after enquiry that the statements, particularly any information contained in this application and in any document accompanying this application are true and correct in every detail and that no other material facts have been misstated, suppressed or missed
Undertake to inform the Company of any material alteration to those facts before completion of the contract of insurance
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Contact us now.
0409 625 698
Send an email
Contact us now.
Email us now
0409 625 698
PO Box 328
Wilston, Qld 4051
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