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 Brokers National 

Brokers National is able to offer you single liability by itself                                      However, single liability without any other policy sections is a more expensive way to insure                                               A packaged commercial policy including a Fire section is generally more economical                                              We can offer a variety of liability covers for: Businesses, Property Owners, Home Businesses, Tradesmen, Social Groups, Entertainment etc.                                           Simply complete the form below

On-Line Public and Products Liability Insurance Quote


Thank you for considering our on-line stand alone public & products insurance quote service. Brokers National has accounts with most insurers and underwriting agencies. We aim to find you the best public & products liability 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.

Public & Products Liability

Business Details:

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


Limit of Liability Required:

   
Public Liability Sum Insured: $ any one occurrence (Min. $5m)
Products Liability Sum Insured: $ each period of Insurance

Property Owners Liability Sum Insured:

 $ any one occurrence
Important: Fully describe all your business activities, but if a property owner list all situations & occupations here:  
Has any Insurer ever declined or refused to renew or cancelled or imposed special terms of conditions to any proposed insurance by You?   No     Yes  
If Yes, please give details:  
Please provide details of all claims made against You or incidents reported to You that may give rise to a claim:  

 Liability Details (If Applicable):

Sub Contractors: Do You Employ Sub Contractors   Amount Paid Sub Contractors $ pa.    Do They Have their Own Insurance  Give Details:

Do You Want To Cover For Sub Contractors   (Note: Premiums Are Higher)
Welding: In Own Factory        Inside Client Premises         Outside On Site
Activities: Manufacture   Distribution    Installation    Repairs   Sales   Consulting
Entertainment: Band/Disco   Solo/Duo   Dance Floor Other

Other Social Activities:

Customers Goods: Yes  No  $10,000 Included OR $ in your physical & legal control
Hoists, Cranes, Unregistered Vehicles: Yes  No  List items:
Driving / Road Risk: Yes  No  Sum Insured Required:$ Limit Per Customers Vehicle
Exporting: Yes  No CountriesExports $ pa.
Importing: Yes  No CountriesImports $ pa.

Any other notes you wish to include OR further list of business or social activities:
 

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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