Bookkeepers, BAS & Tax Agents Quote

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Fortix ID Opportunity

Your Information

Name*

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Name

Business Name

ABN

Best Contact Number*

Email*

Website

Physical Address*

About Your Business

Are you a qualified:*

Bookkeeper
BAS Agent
Tax Agent
Accountant
Other

Please tick all that apply

If other, please specify*

What work do you undertake?*

Recording of Day to Day Transactions
Calculating & Lodging of BAS Related Items
Liaising with ATO on clients behalf
Income Tax Returns
Superannuation Calculations
Superannuation Calculations (For purpose of reducing tax)
Tax Planning Advice & Services for Business Structure, Asset Protection & Strategy
Wealth Creation methods including Superannuation & Investment Strategy

Please tick all that apply

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*

Percentage of work done Overseas*

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

Coverage Required

Level of Cover Required*

If other, please specify*

Do you also require Public Liability Cover?*

Yes
No

If yes, please advise what level of cover is required?*

Claims Experience

The term YOU in the questions below relates to your Firm, Company or you as a Sole Practitioner including present or former Partners, Directors, Principals, Consultants, or Employees.

During the past ten years has any claim been made, or has liability for an error or breach of duty been alleged against YOU; or have any circumstances been notified to insurers which may result in a claim?*

Yes
No

Are YOU, AFTER FULL INQUIRY, aware of any circumstances which may give rise to a claim?*

Yes
No

If Yes, please provide further information*

Have YOU ever been subject to disciplinary proceedings for professional misconduct, any enquiry or audit?*

Yes
No

Has any insurer ever declined to offer Insurance of any type or imposed special terms for YOU?*

Yes
No

If Yes, please provide further information*

Have YOU been charged with or convicted of any criminal offence?*

Yes
No

Have YOU been declared bankrupt, insolvent, had a liquidator appointed or been a defendant in any civil court case?*

Yes
No

If Yes, please provide further information*

Additional Information

Do you have any additional information to add?*

Yes I do
No I don't

Please provide further information*

How did you hear about Webber Insurance?*

Web Search
Referred by Someone
A Building Designer Association
Social Media
Previous / Existing Client
Other

If other, please advise*

We appreciate referrals. Please let us know who provided you with our details*

Other Insurances

Do you require a quote or further information about any of the following 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 advise further information*

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:*

Financial Services Guide
Privacy Policy
Duty of Disclosure
Terms of Engagement

Signature

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

Signature

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Bookkeeper, BAS Agent & Tax Agent Quote Request

Bookkeeper/BAS Agent/Tax Agent Application Form

Your Information

About Your Business

NSW Stamp Duty Declaration

Coverage Required

Claims Experience

Additional Information

Other Insurances

Important Information

Declaration

Signature

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