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 Brokers National 

Brokers National Industrial Special Risks is a package policy available for companies with total assets insured exceeding $3m.                                    Insurance Cover Includes: Fire & Perils & Business Interruption                                              The policy extends to include sub limits for: Burglary, Money, Glass, General Property, Computers, Machinery Breakdown, & Goods InTransit                                             All Covers Are Available Under One Convenient Package Policy                                               Did You Know You Can Select Higher Excesses To Reduce The Premium Payable                                      Simply Answer The Questions Below                                 Type Only The Sums Insured For Sections You Require              

EMAIL Or FAX: 

On-Line Industrial Special Risks Insurance Quote


Thank you for considering our on-line industrial special risks insurance quote service. Brokers National has accounts with most insurers and underwriting agencies. We aim to find you the best industrial special risks insurance deal possible.

Please fill in the following form - answering all questions, then either:

1. Click on "Email to Brokers National" at the bottom of this form.  OR                               

2. Highlight this form to "Print It" and then "Fax It" to our office on 03 9791 6633.


Use the Mouse or the Tab key to move to the next field. We will respond with quotes as soon as they have been received from our insurers.

Business Details:  

Only Complete This Form If Sum Insured Is Over $2m For All Situations

If Sum Insured Is Under $3m Then Click On:   Commercial

Your Current Insurer & Due Date:
Situation of Risk:
(& Postcode)
Business / Trading Name:
Company, Or Partnership Names
Occupation / Trade / Business:
Number of Staff: Full Time       PartTime
Approx. Annual Wages : $ per annum
Estimate Sales / Turnover / Rentals: $ per annum
Building Occupied By:
Years In This Business: years

Property Insurance Details:
Approx. Age of Building:yrs    No.Of Stories:  Approx. Area:sq m
 Condition of Building          
Morgagee / Interested Party
 
Fire Protection: Single sprinklers    Dual sprinklers    Hydrants/Hoses    Extinguishers   Fire Alarm  Thermal Smoke Detectors  
Cooking: Free Standing Frying Vat    Thermostatically Controlled          Bench Top Frying Vat    Griller    Pizza Oven   Rotisserie   Woks 

Construction Details:

Walls: Bricks/Concrete      Iron       Timber       Fibro           Mixed Construction Is
Roof: Iron      Tiles   Other
Floors: Concrete    Timber     Mixed   Other


Security Details:

Details about anti-theft protection you currently have:
Alarm: Monitored    Local Sounding   No Alarm   
Connection: Landline    Securitel    Dialler   No Connection  
Sensors: Infra Red    Window Detector / Tapes   
Deadlocks: All Doors    Other
Other: Security Patrols         24 hour Security Guard            Roller Shutter Front Window        Bars Front Windows      Bars Rear Windows     Safe On Premises    

Please detail briefly any insurance claims in the last five years:

IMPORTANT: Have you ever..........
Had any insurance cancelled or declined?  Yes     No                            
Been charged or convicted of any criminal offence?  Yes  No                          Been bankrupt?  Yes     No  

Liability Details:

Sub Contractors: Do You Employ Sub Contractors    Do They Have Insurance      Give Details
Welding: In Own Factory  Inside Client Premises   Outside On Site
Activities: Manufacturing   Distribution   Installation   Repairs  
Entertainment: Band/Disco   Solo/Duo   Dance Floor Other
Importing: Yes  No CountriesImports $
Exporting: Yes  No CountriesExports $

List Sum Insured Required:

Please enter the value to be insured against each item:

ISR SECTION 1 

Fire and Accidental Damage
Buildings: $
Stock: $
Other Contents: $
Removal of Debris Sub Limit: $
Loss of Rent: $
Other Specified Property: $
Accidental Damage Sub Limit: $
 Business Interruption
Gross Profit or Rent: $
Increased Cost of Working Sub Limit: $
Claims Preparation Costs Sub Limit: $
Payroll% for Weeks $
ISR Sub Limits (Please Select)

Burglary
Stock: $
Tobacco / Cigarettes: $
All Other Contents: $
Liquor / Alcohol $
Damage To Premises $
Money
In Transit: $
Business Hours $
Outside Business Hours $
Locked Safe: $
Residence: $
Glass
External:
 Internal:
Signs: $
General Property / Tools Of Trade / Mobile Equipment
General Property Total Limit: $
Single Item Limit: $   1,000
Specified Items Over $1,000 Per Item: $
Computers (Breakdown Only)
Electronic Equipment: $
Data Media $
Increased Costs $
Machinery Breakdown
Unspecified Equipment: $
Specified Items: $      
List Machines To Be Insured Below:

                                      : 
Food Spoilage: $
Goods in Transit
Goods in Transit Per Load: $
No. Of Vehicles To Be Insured Vehicles

Contacting you about your quote:

Please make sure you leave a contact phone number and the best time to call you.
Your Name:
Company name:
Your Phone Number & Area Code:
Best Time(s) To Call:
Please send my quote by (select at least one): email     phone     fax     mail
Your Email:
Your Facsimile:
Your Postal Address:

Click On Email Quote To Send Form To Us
 

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