Public Liability Insurance Quote Online Form

Please complete the following information and submit this form to obtain a public liability insurance quotation for your business.

Click on one of the following links if you would like to obtain a quote for another type of insurance product.

Business Insurance
Trades Insurance

All information you provide must be correct, true, and accurate as incorrect or misleading information may alter our quote and jeopardise cover if you proceed with a policy.

Please refer to the CGIB Financial Services Guide, Privacy Statement, General Advice Warning and Duty of Disclosure before completing this form.

Business Name/Insured*

Business Address
Street Name and Number*	Post Code*	City/Town*

Business Occupation*
Fully describe all the products and/or services your business provides*

Business Website Address	ABN Number

Sum Insured Required*
Driving Risk	$ Public and Products Liability - Driving Risk Damage to any registered vehicle not owned or leased by You (Insured) but Your (Insured) physical or legal control for the purposes of repairs, servicing or garaging whilst such Vehicle is on any Public roadway or throughfare whilst being tested and/or collected and/or collected and/or delivered.

Do you employ sub / contractors*	Yes No
Annual payments to sub / contractors*	$
Do you use labour hire*	Yes No
Annual payments to Labour Hire*	$
Does the business import &/or export?*
Please provide details (inc Country, Products, etc)*
Is your business licensed to sell alcohol?*	Yes No
Total Number of Staff*
Annual Business Turnover*	$

Do your operations include any of the following?
- work at airports, railway, oilrigs, gas rigs, oil refineries, chemical refineries, mines or quarries, ship yards?*	Yes No
- work with/on cooling towers, alarm systems or mainframe computers?*	Yes No
- boilers and/or compressors which require Government certificates?*	Yes No
- manufacture, distribution, storage, transportation, of chemicals or other toxic or harmful matter?*	Yes No
- use or storage of explosives?*	Yes No
- provide any advice, design or professional services, whether or not a fee is charged for such advice, design or professional service?*	Yes No
- conduct any welding?*	Yes No
If yes to any of the above, please provide details

Have you ever suffered any losses or claims?*	Yes No
Have you ever had any insurance cancelled or declined or special terms imposed?*	Yes No
Have you ever been charged or convicted of any criminal offence or declared bankrupt?*	Yes No
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?*	Yes No
If yes to any of the above, please provide details

Phone Number*	(please include area code)
Fax Number	(please include area code)
Email Address*
How did you find us?*		Please provide details
Comments

Public Liability Insurance Quote Online Form

INSURED'S Details

INSURANCE Details

PUBLIC & PRODUCTS LIABILITY

Public and Products Liability - Driving Risk

PREVIOUS INSURANCE - Details - MUST COMPLETE ALL QUESTIONS

CONTACT Details

Please provide the date your existing policy expires*
Please provide the name of the Insurer*
Please confirm the Insurer name*

First Name*
Surname*