Architect Renewal Declaration Request

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Work Request ID

Your Information

Name*

Business Name

ABN

Best Contact Number*

Email*

Website

Has your business address changed in the past 12 months?*

Yes
No

Address*

About Your Business

Occupation*

Normal Duties*

Gross Fees - Projected this Financial Year*

Gross Fees - Last Financial Year

States where business is conducted?*

Percentage of work done in ACT*

Percentage of work done in NSW*

Percentage of work done in NT*

Percentage of work done in QLD*

Percentage of work done in SA*

Percentage of work done in TAS*

Percentage of work done in VIC*

Percentage of work done in WA*

If overseas, please advise further details of work undertaken*

NSW Stamp Duty Declaration

Are you a small business Individual / Partnership / Company and/or Trust, which is carrying on a business, and the business has an aggregated turnover of less than $2 million*

Yes
No

Aggregated turnover is your Australia wide annual turnover plus the annual turnovers of any business entities that are your affiliates or are connected with you.

Click here to read more about this exemption

Number of suitably qualified people in the business*

Details of their qualifications*

List the professional bodies or associations that you or the company belong to?

Is any Partner, Principal or Director connected or associated (financially or otherwise) with any other practice or business?*

Yes
No

If yes, please provide details*

Work Undertaken

Type of Work undertaken?*

Please check as many that are applicable to your line of work.

Percentage of Architecture Work*

Percentage of Construction Management Work*

Percentage of Drafting Work*

Percentage of Heritage or Preservation Consulting Work*

Percentage of Interior Design Work*

Percentage of Landscape Architecture Work*

Percentage of Modular Designs Work*

Percentage of Pre-Purchase Inspections Work*

Percentage of Project Management Work*

Percentage of Soil Testing / Site Investigations Work*

Percentage of Town Planning Work*

Percentage of Work with Dams, Harbours & Jetties*

Percentage of Work with Bridges, Mines, Tunnels or Offshore Projects*

Percentage of Other Work*

If other, please provide details

Field of Work

Type of Premises where work is undertaken?*

Domestic
Commercial
Institutional
Industrial
High Rise
Other

Please tick all that apply.

Percentage of Domestic Work*

Percentage of Commercial Work*

Percentage of Institutional Work*

Percentage of Industrial Work*

Percentage of High Rise Work*

Percentage of Dams Work*

Percentage of Oil & Gas Work*

Percentage of Other Work*

If other, please provide details*

Please provide an overview of the largest 5 jobs you have undertaken in the past 5 years.*

Non-Conforming Building Materials

In the past 10 years, have you designed, certified, specified or recommended any building material that does not fully comply with all requirements for use in or on any commercial, industrial and/or residential structure as specified by the Building Code of Australia, and/or any other building code requirements of the relevant State or Territory, at the time of such design, certification, specification or recommendation?*

Yes I have
No I haven't
I am not sure, can we discuss further

For further information on Non-Conforming Building Materials and to better understand what these products are, please refer here.

If yes, please advise what type of buildings this relates to*

Residential Buildings – up to 2 stories in height
Residential Buildings – over 2 stories in height
Schools, Nursing Homes, Hospitals, Medical Facilities, Aged Care Homes, Child Care Facilities, Municipal Buildings and Recreation Centres
Other Commercial Buildings
Other Building Types - Not Listed Above

If other, please provide further details*

Please provide details of these projects including types of materials, value of project and the size of the buildings*

If you are unsure please provide further details*

Non-Disclosure Re Non-Conforming Building Materials
It is imperative that careful consideration be given to the above Non-Conforming Building Materials questions. If there is an incorrect statement or inadequate disclosure, such that the risk is underwritten by Insurers when with proper disclosure, the risk would have been declined, this will mean that any claim involving Non-Conforming Building Materials will be rejected by Insurers.

Limits of Cover Required

Level of Cover Required*

If other, please advise limit required*

Do you also require Public Liability Cover?*

Yes
No

If yes, what limit to do require?*

$5 million
$10 million
$20 million
Other

If other, please advise limit required*

Contractors & Consultants

Do you engage consultants, sub-contractors or agents?*

Yes
No

What type of work do these Contractors & Consultants do for your business?*

How much is paid to contractors annually?*

Do you insist they carry their own Professional Indemnity Insurance?*

Yes we do
No we don't
Some do, some don't

Risk Management

Are verbal reports always confirmed in writing?*

Yes
No
We don't provide verbal reports

If No, how do you substantiate such verbal reports?

Do you enter into any hold-harmless agreements or otherwise waive any legal rights or entitlements which you may have against such consultants, sub-contractors or agents?*

Yes, we do
No, we don't
I am unsure

Design & Construct

Does your business undertake any construction services itself- i.e Design & Construct?*

Yes
No

What Design & Construct services do you undertake?*

We Design & Construct from our own design and provide full technical supervision of the build
We Construct from designs by appointed sub-contractors
We Construct only with no design or professional service
We Design and provide technical supervision only (No Construction)
Other

Tick all that are applicable

Estimated fees earned from Design & Construct services*

Estimated fees/turnover earned from Construction using sub-contracted designs*

Estimated turnover earned from Construction only services*

Estimated fees/turnover earned from Design/Supervision only services*

Please advise other services*

Estimated fees/turnover earned from Other services*

Claims Experience

After all due and proper enquiries, I/We hereby declare that I/We am/are aware:

Of any incidents, facts or circumstances which may give rise to a claim against the firm, company or sole practitioner, its predecessors in business or any past or present partners, directors, principals, consultants or employees?*

Yes, I have something to notify
No, there is nothing to declare
I have previously declared an incident to my insurer and have nothing new to declare

If Yes, please provide further information*

Other Insurances

Do you require a quote or additional information on any other insurances?

Office / Contents Insurance
Management Liability Insurance
Cyber / Privacy Protection Insurance
Motor Vehicle Insurance
Income Protection / Life Insurance
Construction / Contract Works Insurance
Tools / Mobile Equipment Insurance
Home Insurance
Other Insurance

If other, please provide further information

Additional Information

Is there any other information or business changes that you need to provide to the insurer?*

YES there is
NO there is not

Please provide further details*

Important Information

Please take a moment to read these important documents prior to submitting your form.

Declaration

I/WE declare that we have read the important notices attached above and I/WE understand those notices.
I/WE undertake to inform insurers of any material alteration to these facts whether occurring before or after completion of the Contract of Insurance.
I/WE hereby acknowledge that the insurance cover may be provided in whole or in part by overseas insurers.

Please tick all to confirm that you have read the following documents:*

Privacy Policy
Financial Services Guide
Duty of Disclosure
Terms of Engagement

Signature

This electronic signature will be treated the same as if signed personally.

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