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Building/Pest Inspections & Pest Management Insurance Application

Proposer Detail(s)
*Required
 

Number of employees including directors and principals

Please provide turnover split based on the following occupation tables applicable to your business activities

Building Inspectors(Non-pest)

Pest Management, Timber Pest and Termite Inspections

Other Activities

Limit of indemnity required

For the avoidance of doubt, the Proffessional Indemnity cover is issued on claims made and notified basis.

(any one occurrence and in the annual aggregate in respect of Products Liability)

(in the aggregate for the period of Insurance)
Please note limits are $1,000,000 automatically for building inspections
Professional Indemnity Retroactive Date (the date that you first had continuous Professional Indemnity cover, without any lapses in cover).

Details of Income

Please provide a percentage break down of turnover disclosed

Please advise where you will be conducting your building inspections (non pest) past management, timber pest and termite inspections.

Please confirm the qualifications and experience for all personnel to be covered under this policy specific to the activities noted in this application?

Please enter details for each applicant

Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.
Upload any certificates or qualifications here.
Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.
Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.
If “Yes”, please provide the following details
Risk Management & Compliance
If “Yes”, please advise whether you comply with all statutory obligations, by-laws and/or regulations imposed by any relevant authorities for the ownership, use and/or storage of firearms and explosive devices and/or stored in connection with your business activities only?

Please confirm the follow regarding your reports?

Is your work conducted strictly in accordance with one or more of the following Australian Standards applicable to your business activities?
Report Systems Australia Pty Ltd Handbook System
National Pest Management Industry Competency Standards, Unit 8 & 10 “Inspect and Report on Timber Pests”
Current versions of Australia Standards AS 3660, AS 4349.3 and/or AS 4349.1

Premises & activity risk

If “Yes”, please provide specific details below

If “Yes”, please provide specific details below

refineries, chemical plant, petrol, oil or gas production facilities, offshore platforms/oil rigs, utilities, oil or gas pipelines, power stations, laboratories, water treatment plants, railway infrastructure, airports, underground work, dams, work on trains, watercraft or aircraft: If “Yes” please specify below

Claims History – Broadform Liability

If “Yes”, please supply details below

Claims History – Professional Indemnity

Have any claims for professional negligence or breach of professional duty been made in the last 10 years against any applicant or any of their predecessors in business or any prior business of any of their present or former directors, partners, or principles?

General Information

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

Conditions

This declaration must be completed and signed by or on behalf of the party applying for insurance.  I/We 
a) declare that:
i.  the answers and information given by me/us in this Application are true and correct in all respects;
ii.  no information has been withheld that would affect the Underwriters decision to accept this Application;
iii.    where answers in this Application are not my/our own handwriting, they have been checked by me/us and I/we agree they are correct;
iv.    I/we have read and understood the clauses detailed under the Important Notices section at the front of this Application;
v.  if there was insufficient space to fully answer any questions, I/we have attached supplementary pages providing the additional information required;
vi.  I/we have read and understood the Financial Services Guide and Privacy Statement.

b)   authorise the underwriter to give to, or obtain from other insurers or an insurance or credit reference bureau, any information relating to these insurance covers and any other insurances held by me/us and claims under those insurances.

c)  have received a copy of the Policy terms and conditions and agree to be bound by the terms and conditions in it.

Declaration

By signing this declaration electronically below you agree to the above

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