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Business Insurance Scheme Form

BBASS Proposal Form

YOUR DETAILS

Full Name
Full Name
First
Last
Structure
11 Digits
GST Registered

ADDRESS

Physical Address

Address
Address
City
State/Province
Zip/Postal
Postal Address
Same as Physical Address
Address
Address
City
State/Province
Zip/Postal

OTHER DETAILS

Do you hold a Tax Practitioners Board Registration
Do you belong to any Association

DUTY OF DISCLOSURE

Before you enter into a Contract of general insurance with an Insurer, you have a duty under the Insurance Contracts Act 1984 to disclose to the Insurer every matter that you know, or could reasonably expect to know, is relevant to the Insurer's decision whether to accept the risk of Insurance and if so, on what terms. You have the same duty to disclose those matters to the Insurer before you renew, extend, vary or reinstate a Contract of general insurance. Your duty however does not require disclosure of matter.

  • that diminishes the risk to be undertaken by the Insurer
  • that is common knowledge
  • that your Insurer knows or, in the ordinary course of business, ought to know
  • as to which the compliance with your duty is waived by the insurer

Non-Disclosure
If you fail to comply with your duty of disclosure, the Insurer may be entitled to reduce the liability under the Contract in respect of a claim or may cancel the Contract. If your non-disclosure is fraudulent, the Insurer may also have the option of avoiding the Contract from its beginning.
Answer all questions correctly to comply with your duty of disclosure.

Do you understand your Duty of Disclosure

IN THE LAST FIVE YEARS HAVE YOU OR THE BUSINESS EVER HAD

Any Claims
Any Convictions
Ever Been Declared Bankrupt

YOUR INSURANCE DETAILS

Are you currently insured
Do you want to upload your current policy or renewal notice?
Maximum upload size: 5MB

BUSINESS ACTIVITIES OR SERVICES PROVIDED

You can select more than one option

TURNOVER

Turnover is the total gross sales/invoices generated by the business, less the GST, but including all payments made to sub-contractors. Turnover is not the actual or estimated profit or pre-tax profit of the business.

STAFF

COVER REQUIRED

SUB-CONTRACTORS

Do you wish to name any Sub-contractors

Sub-contractors can be covered at additional cost

IMPORTANT INFORMATION

Sub-Contractors

This Policy covers you for the vicarious liability arising from any sub-contractor you engage, but does not cover the actual sub-contractor.

We remind you of the importance of ensuring that all contractors and sub-contractors used by you; maintain adequate professional indemnity, public & products liability and workers compensation insurances. You should ensure their cover is in force before you authorise any work to commence and annually check that these covers are in place.

Sub-contractors that provide work or services for you will NOT be covered under this insurance, unless you have named them on your policy. To cover them under your insurance, only for services provided for and on your behalf, their details must be provided below

Important: Cover under the Professional Indemnity policy will only last for as long as they remain named on the policy, once removed, all cover will cease from that point. The sub-contractor will NOT be covered for claims made after that date, even if they were on cover at the time a claim occurred. This is due to the “Claims Made” insuring clause of a Professional Indemnity policy. Sub-contractors that hold their own insurance do not need to be named

I HAVE READ AND UNDERSTOOD

DECLARATION

I/We hereby declare that:

My/Our attention has been drawn to the Important Notice of this Proposal form and further I/We have read these notices carefully and acknowledge my/our understanding of their content by my/our signature/s below.

The above statements are true, and I/we have not suppressed or misstated any facts and should any information given by me/us alter between the date of this Proposal form and the inception date of the insurance to which this Proposal relates I/we shall give immediately notice thereof.

I/We authorise you, to collect or disclose any personal information relating to this insurance to/from any insurers or insurance reference service. Where I/we have provided information about another individual I/we declare that the individual has been or will be made aware of that fact.

I/we also confirm that the undersigned is/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this Proposal form, and I/we complete this Proposal form on their behalf.

Where a Policy is issued on a “minimum and deposit” premium basis, the annual premium is a minimum and deposit premium, which means that there is no refund of any premium or fees and charges in the event you cancel the policy before the normal expiry date or the policy is cancelled by the insurer prior to the normal expiry date. By signing this proposal form you acknowledge your understanding and acceptance of this condition.

Your Name
Your Name
First
Last