Building Inspectors Quote Request

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Fortix ID Opportunity

Your Information

Name*

Business Name

ABN

Best Contact Number*

Email*

Website

Address*

About Your Business

Number of Employees*

Gross Fees - Projected this Financial Year*

What states do you receive your fees from?*

Percentage of fees received in NSW*

Percentage of fees received in VIC*

Percentage of fees received in QLD*

Percentage of fees received in SA*

Percentage of fees received in WA*

Percentage of fees received in TAS*

Percentage of fees received in NT*

Percentage of fees received in ACT*

Percentage of fees received Overseas*

If overseas, please provide further details including countries fees received from*

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

Type of work undertaken*

If other, please advise*

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Number of years of Inspection experience

Number of years of Inspection experience*

0 - 5 years
5 - 10 years
10+ years

Note: This question is referring to your number of year’s experience as a Building Inspector, not your overall experience in the construction industry.

Inspectors with less than 5 years experience

Unfortunately, we are unable to assist with providing insurance cover to any building inspector that has less than 5 years experience.

Insurance Details

Are you currently insured for Professional Indemnity Insurance?*

Yes
No

Current Policy Expiry Date*

Current Insurer*

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If yes, please provide renewal date & current insurer

Level of Professional Indemnity Cover Required*

If other, please advise limit?*

Do you also require Public Liability Cover?*

Yes
No

If yes, what level of cover do you need?*

$5,000,000
$10,000,000
$20,000,000
Other

If other, please advise*

Risk Management

Overall Experience and Qualifications*

Please specify your current accreditations and past experiences. Your CV can be attached at the end of this form if available.

Have you completed a Building Inspection course?*

Yes
No
Other

Please provide details of the course undertaken*

If other, please provide further details*

Do you engage sub-contractors?*

Yes
No
Other

If yes, do you insist they carry their own Professional Indemnity insurance?

Yes
No
Other

If other, please provide further details*

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 advise further details.*

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 advise further details.*

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 advise further details.*

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

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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Your Information

About Your Business

NSW Stamp Duty Declaration

Inspectors with less than 5 years experience

Insurance Details

Risk Management

Claims Experience

Additional Information

Other Insurances

Important Information

Declaration

Signature

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