Public & Products Liability Insurance Form

Public & Products Liability Cover

Email

Contact Number

Property Owner Liability only?

YesNo

What is the estimated sum you will pay to contractors, sub-contractors or labour hire companies in the next 12 months?(You do not need to include payments to yourself.)

Estimate the amount to be paid in the next 12 months:

Subcontractors - Labour only:

Subcontractors - Labour and plant:

Subcontractors - Labour, plant and materials:

Labour Hire - Labour Hire Firms:

Do you, or do you intend to, hire in equipment or hire out equipment and/or staff?

YesNo

What type(s) of work do staff from labour hire firms perform for you?

Is there a Hire Agreement with a disclaimer or legal waiver in place that the hirer signs before hiring?

YesNo

Is all equipment checked and maintained after each hire?

YesNo

Do you, or do you intend to, perform work away from your own premises?

YesNo

Do you, or do you intend to, perform external work over 2 storeys or 10 metres high?

YesNo

Limit of Liability - Public & Products Liability:

$5,000,000$10,000,000$15,000,000$20,000,000

Does your business import or export goods?

YesNo

Are there any interested parties you would like covered under this policy?

YesNo

Do you, or do you intend to, use, store or handle hazardous substances?

YesNo

What substances and what is the process for handling and storage?

Do you, or do you intend to, discharge waste or hazardous material into the atmosphere, sewer or elsewhere?

YesNo

Do you maintain records identifying suppliers of all goods?

YesNo

Do you, or do you intend to, advertise your products and/or services?

YesNo

Claims History:

Any claims in the last 3 years under the sections to be insured?

YesNo

Is there anything else that might be relevant you want to share?

YesNo