Tradesman Insurance Quote Request Form

Hidden

Fortix ID Opportunity

Your Information

Name*

Business Name

ABN

Email*

Best Contact Number*

Website

Business Address*

**Can be home address if no physical business address

About Your Business

Hidden

Occupation*

Describe the work you do*

Do you perform work at or on any of the following:*

If yes, please provide further information*

Estimated turnover for next 12 months*

Number of staff employed

Do you engage contractors or labour hire?*

Yes
No
Unsure

If yes, type of work conducted by contractors and/or labour hire?*

Annual estimated payments to contractors

Annual estimated payments for labour hire

Do contractors hold their own insurance cover?*

Yes, they all do
Yes, some do
No they don't
Unsure

Insurance Cover Required

Quotes required for:*

Public Liability
Tools Cover
Personal Accident
Motor Vehicle/s
Plant &/or Equipment
Workers Compensation (ACT, WA, TAS & NT only)
Other

If yes, what level of public liability cover is required?*

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

Tools Cover

How much cover is required for tools?*

If other, please advise amount*

Do you own any tools that are worth over $2,500? If yes, please provide further details including value of each item over $2,500

Personal Accident Cover

Date of birth*

Weekly benefit limit required

If other, please advise*

Type of cover required*

Accident Only
Accident & Illness

Death cover benefit required*

If other, please advise*

Excess limit required*

14 days
21 days
28 days
Other

If other, please advise*

Motor Vehicle Cover

Please provide further information on what needs to be covered*

Plant & Equipment Cover

Please provide information on what needs to be covered*

Workers Compensation

Please provide details of employees and/or directors that need cover*

Other Insurance

If other insurance is required, please provide further details*

Other Information

Please provide further information

After investigation, are you or any principal, partner, or director aware*

Of any insurance being declined or cancelled, application / proposal rejected, renewal refused, claim rejected, or special conditions or excess imposed by any insurer
Of any claims made against you
Of any of your products being recalled
Of an incident or accident which would be insured by this proposed insurance
Anyone having been charged with or convicted of any criminal offence (excluding traffic offences)
Have you ever, either alone or jointly with others been declared bankrupt or subject to any form of insolvency administration (eg. liquidation or receivership)
None of the above

If you have answered ‘Yes’ to any of the above questions, please provide full details. For claims or uninsured losses, please detail the total cost of the claim, date of loss, how the loss occurred, the name of insurer and the policy number*

Other Information

Do you have any further information to add?*

Yes I do
No I don't

Any further information*

Confirmation of Details

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.

About Us

Read more about our Business and Partners.

Blog Posts & Ultimate Guides

Read our latest blog posts plus get further information on key topics in our ultimate guide pages.

Insurance Products

We will find you the right insurance product for your business.

Occupations

We can source insurance for all kinds of occupations.

Schemes

Insurance schemes for various occupations and industries.

Get A Quote

We work to simplify the insurance process for our clients.

Tradesman Insurance Quote Request

Your Information

About Your Business

Insurance Cover Required

Tools Cover

Personal Accident Cover

Motor Vehicle Cover

Plant & Equipment Cover

Workers Compensation

Other Insurance

Other Information

Other Information

Confirmation of Details

Signature

Get a BDAA Insurance Quote

Request Insurance Advice