Request a Quote

To help us provide an accurate quote, please complete the following questions:

What types of insurance do you require?*

Professional Indemnity

Public Liability

Management Liability

Construction and Public Liability

Income Protection

Cyber Insurance

Other

What is the other?

How did you hear about us?

Provide some information about your company / business:

Company Name*

Contact Name

First Last

Position

Contact Number

Email*

Address

List full name of all current entities and prior incorporated to be insured:

It is essential to specify the names of all entities including trading names, service, administrative or nominee companies and subsidiaries that you wish to be covered by this policy.

Name(s)

ABN

ACN

Date Established

What is your primary profession?

Have any claims or allegations of negligence or breach of professional duty been made in the last 10 years against the practice (or any of its predecessors in business or any prior practice of any of their present or former partners, principals or directors), OR have circumstances been notified to insurers that might give rise to a claim?*

We may ask you additional information about this.

Provide details of each principal/partner/director

Name

First Last

Age

Registered

Years in practice

Qualifications

Institute / Association Membership

Name

First Last

Age

Registered

Years in practice

Qualifications

Institute / Association Membership

Name

First Last

Age

Registered

Years in practice

Qualifications

Institute / Association Membership

Please complete the following Public Liability related fields:

Select your required Limit of Indemnity for Public Liability insurance

$10,000,000

$20,000,000

How many staff does your practice currently have?

Does your practice currently hold Professional Indemnity insurance?

Expiring Date

Policy Premium

Current Insurer

Provide details of the practice’s professional fees below:

Professional fees earned for last 12 months (Excluding GST):

Australia

Overseas

Estimated professional fees for the next 12 months (Excluding GST):

Australia

Overseas

Provide a breakdown of professional fees earned for the last 12 months:

(If a new practice, provide an estimate)

ACT

Please enter a number from 0 to 100.00.

NSW

Please enter a number from 0 to 100.00.

NT

Please enter a number from 0 to 100.00.

QLD

Please enter a number from 0 to 100.00.

SA

Please enter a number from 0 to 100.00.

TAS

Please enter a number from 0 to 100.00.

VIC

Please enter a number from 0 to 100.00.

WA

Please enter a number from 0 to 100.00.

Overseas

Please enter a number from 0 to 100.00.

This field is hidden when viewing the form

Calculate State

Please make sure your total professional fee breakdown is equal to 100%.

Please complete the following Professional Indemnity related questions:

Select your required Limit of Indemnity for Professional Indemnity insurance

$1,000,000

$2,000,000

$5,000,000

$10,000,000

$20,000,000

Uncertain

Do you engage consultants, sub-contractors or agents?

Do you insist they carry their own Professional Indemnity insurance?

List professions of the subconsultants (if any)

Has the practice or any related entity ever engaged in or had a share of an entity engaged in:

Actual construction, fabrication, erection or any form of building contracting?

Real estate development?

Manufacture, sale or distribution of any product or process or patented production process?

If the answer to any of the above is YES, list the names of the other entities involved and describe the relationship:

Express as a percentage, the practice’s professional fees derived from the following activities:

Architecture

Please enter a number from 0 to 100.00.

Interior Design

Please enter a number from 0 to 100.00.

Landscape Architecture

Please enter a number from 0 to 100.00.

Town Planning

Please enter a number from 0 to 100.00.

Drafting / Building Designing

Please enter a number from 0 to 100.00.

Heritage Consulting

Please enter a number from 0 to 100.00.

Project / Construction Management

Please enter a number from 0 to 100.00.

Environmental Consultancy

Please enter a number from 0 to 100.00.

Energy Rater

Please enter a number from 0 to 100.00.

Engineering – Structural

Please enter a number from 0 to 100.00.

Engineering – HVAC

Please enter a number from 0 to 100.00.

Engineering – Acoustical

Please enter a number from 0 to 100.00.

Engineering – Geo Tech / Soil

Please enter a number from 0 to 100.00.

Engineering – Plumbing

Please enter a number from 0 to 100.00.

Engineering – Environmental

Please enter a number from 0 to 100.00.

Engineering – Mining

Please enter a number from 0 to 100.00.

Engineering – Nuclear

Please enter a number from 0 to 100.00.

Engineering – Marine

Please enter a number from 0 to 100.00.

Engineering – Civil

Please enter a number from 0 to 100.00.

Engineering – Mechanical

Please enter a number from 0 to 100.00.

Engineering – Electrical

Please enter a number from 0 to 100.00.

Engineering – Fire Protection

Please enter a number from 0 to 100.00.

Engineering – Chemical

Please enter a number from 0 to 100.00.

Land Surveying

Please enter a number from 0 to 100.00.

Building Surveying

Please enter a number from 0 to 100.00.

Quantity Surveying

Please enter a number from 0 to 100.00.

Marine Surveying

Please enter a number from 0 to 100.00.

Engineering Surveying

Please enter a number from 0 to 100.00.

Teaching / Lecturing / Education

Please enter a number from 0 to 100.00.

TV / Film / Theatre / Set / Exhibition / Display

Please enter a number from 0 to 100.00.

Multimedia / Digital Media / Visual Communication / Web Design / Graphic Design

Please enter a number from 0 to 100.00.

Hydraulic / Fire Design

Please enter a number from 0 to 100.00.

Furniture / Product Design

Please enter a number from 0 to 100.00.

Industrial Design

Please enter a number from 0 to 100.00.

Other

Please enter a number from 0 to 100.00.

Other Activity

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Calculate Activities

Please make sure your total activities are equal 100%.

Express as a percentage, the approximate work undertaken in the following areas:

Town Planning

Please enter a number from 0 to 100.00.

Domestic Buildings

Please enter a number from 0 to 100.00.

Commercial / Industrial Buildings

Please enter a number from 0 to 100.00.

Interior Design

Please enter a number from 0 to 100.00.

Landscape Architecture

Please enter a number from 0 to 100.00.

Low Rise Buildings (up to 5 storeys)

Please enter a number from 0 to 100.00.

High Rise Buildings (above 5 storeys)

Please enter a number from 0 to 100.00.

Product Design

Please enter a number from 0 to 100.00.

Building Inspections

Please enter a number from 0 to 100.00.

Commercial Tenancy Fitout

Please enter a number from 0 to 100.00.

Roads / Drainage

Please enter a number from 0 to 100.00.

Schools, Hospitals, Municipal Buildings

Please enter a number from 0 to 100.00.

Trade Shows, Exhibitions

Please enter a number from 0 to 100.00.

Aged Care

Please enter a number from 0 to 100.00.

Environmental Appraisals / Impact Assessments / Audits

Please enter a number from 0 to 100.00.

Acoustic & Noise Prevention

Please enter a number from 0 to 100.00.

Sports Centres / Clubs

Please enter a number from 0 to 100.00.

Swimming Pools Commercial

Please enter a number from 0 to 100.00.

Retail Shops, Flats, Townhouses

Please enter a number from 0 to 100.00.

Swimming Pools Domestic

Please enter a number from 0 to 100.00.

Aquatic Centres

Please enter a number from 0 to 100.00.

Heritage Premises

Please enter a number from 0 to 100.00.

Modular Buildings (involving repetitive design)

Please enter a number from 0 to 100.00.

Teaching / Lecturing

Please enter a number from 0 to 100.00.

Feasibility Studies, Investigation or Reports

Please enter a number from 0 to 100.00.

Expert Witness / Mediation

Please enter a number from 0 to 100.00.

Bridges / Tunnels

Please enter a number from 0 to 100.00.

Pre-Purchased Building Inspections

Please enter a number from 0 to 100.00.

Domestic Surveying

Please enter a number from 0 to 100.00.

Commercial Surveying

Please enter a number from 0 to 100.00.

Subdivisions

Please enter a number from 0 to 100.00.

Dams

Please enter a number from 0 to 100.00.

Mines

Please enter a number from 0 to 100.00.

Harbours / Jetties / Marinas / Waterfronts

Please enter a number from 0 to 100.00.

Hotels / Motels / Pubs

Please enter a number from 0 to 100.00.

Soil Testing & Foundations Investigation

Please enter a number from 0 to 100.00.

Foundations Underpinning

Please enter a number from 0 to 100.00.

Sewerage, Water Systems - Commercial

Please enter a number from 0 to 100.00.

Sewerage, Water Systems - Domestic

Please enter a number from 0 to 100.00.

Oil & Gas Pipelines

Please enter a number from 0 to 100.00.

Petrochemicals / Refineries / Fertilizers

Please enter a number from 0 to 100.00.

Structures at Fairs

Please enter a number from 0 to 100.00.

Commercial Surveying

Please enter a number from 0 to 100.00.

Mechanical Plant & Bulk Handling Equipment inc Silos

Please enter a number from 0 to 100.00.

Risk and Hazard Assessments

Please enter a number from 0 to 100.00.

Waste Disposal, Treatment or Management

Please enter a number from 0 to 100.00.

Energy Rating Assessment / HMB Assessor

Please enter a number from 0 to 100.00.

Playgrounds

Please enter a number from 0 to 100.00.

Other

Please enter a number from 0 to 100.00.

Other Area

This field is hidden when viewing the form

Calculate Areas

Please make sure the areas of work are equal to 100%.

Please complete the following Management Liability related fields:

Select your required Limit of Indemnity for Management Liability insurance

$1,000,000

$2,000,000

$5,000,000

Number of Staff

Number of Sub Consultants

Please enter a number from 0 to 100.

Include Directors and Officers Liability

Provides indemnity for any Wrongful Act by any Director and/or Responsible Person in carrying out their duty as a Director or Responsible Person of the Named Organisation. This section does not extend to the Directors’ and/or Responsible Persons’ requirement to attend inquiries etc.

Fidelity / Tax Required:

Include Organisational Liability:

Indemnifies the Organisation should they be joined in an action with the Directors and Officers following a breach of their duties.

Entity Contractors Endorsement

The definition of Insured is extended to include the following listed entities, engaged by the Insured in the course of their business, but only for Claims arising from circumstances that occur during the duration of the contract and in relation to tasks performed to satisfy the contract.

Include Fidelity / Tax Required

Please complete the following Construction Insurance related fields:

Type of Contract Works & Liability required

Project Details

Commencement Date

Expiration Date

Owner Builder?

Project Address

Scope of Works

Has work commenced?

If Yes: What Date?

Will any alterations or refurbishments to existing structures be undertaken?

If Yes: Existing Structures Description

Is there any Demolition?

If Yes: Demolition Description

Include the Site Geology

Sum Insured & Insured Property

Contract Value

Principal Supplied Materials

Existing Structures

Tools, Plant & Equipment

Select your required Limit of Indemnity for Public Liability

$10,000,000

$20,000,000

Other

Additional Information

Please Note: Subject to the information provided, we may be in touch to clarify or obtain further information in relation to your contract.

Provide the current percentage of Activities:

Residential - New Single Dwelling

Residential - Apartments/Multi Units >3

Residential – Alterations/Additions

Commercial Construction

Industrial

Civil

Provide the current percentage of Territorial Limits:

VIC

NSW

QLD

ACT

NT

SA

WA

TAS

Period of Insurance:

From

Effective at 4pm

To

Effective at 4pm

Current Policy Basis

Transfer – Insuring actual turnover undertaken

Run Off – Insuring contract value of all contracts commencing

Max Construction Period

Estimate in months

Turnover or value of Contracts

Current Premium

Current Broker

Current Insurer

Material Damage:

Contract Works (value of your largest contract)

Major Plant & Equipment (over $5k per item)

Minor Plant & Equipment (under $5k per item)

Materials in Transit

Materials in Storage

Sub Limits:
Please complete below if you require specific limits or tick the box for the Insurers standard limits.

Provide a quotation with the Insurers standard limits

- OR -

Removal of Debris

Professional Fees

Expediting Expenses

Mitigation Expenses

Escalation/Variations

Liability:

Select your limit for Public & Products Liability

$10,000,000

$20,000,000

Deductibles:

Material Damage

Legal Liability

Legal Liability – Worker to Worker

Claims Experience:

Date

Description

Claim Value

Deductible

Other Insurance Requirements

Please advise if you are interested in obtaining details regarding the following insurance products to further protect your business:

Insurance Products

Office or Business Insurance

Business Travel Insurance

Contract Works Insurance

Fleet Motor Insurance

Life / TPD Insurance

Income Protection Insurance

What are the current Policy Expiry Dates (if applicable):

Office or Business Insurance

Business Travel Insurance

Contract Works Insurance

Fleet Motor Insurance

Life / TPD Insurance

Income Protection Insurance

Please provide any supporting documents:

Include CV / qualifications for startup practices or a Policy Schedule / Certificate for your current policy.

Upload Documents

Drop files here or

Max. file size: 30 MB.

Additional Comments or Questions

Declaration

I confirm that I am authorised to provide and confirm this information on behalf of the person or entity seeking insurance. I have reviewed the information above and, to the best of my knowledge, it is complete and accurate. I understand that the information may be provided to and relied upon by the relevant underwriter and insurer when assessing the risk and considering whether to offer insurance terms. I will promptly advise Planned Cover if any information is incorrect or changes before insurance cover is arranged.

Enquiry should be made of all principals/partners/directors and senior staff to ensure full disclosure.
Agreeing to the above does not bind the practice to accept the insurance or the insurers to provide a quotation.

Signee

Firstname Lastname

Date

Co-Signer

Firstname Lastname

Date

Request A Quote

To help us provide an accurate quote, please complete the following questions:

Provide some information about your company / business:

List full name of all current entities and prior incorporated to be insured:

Please complete the following Public Liability related fields:

Provide details of the practice’s professional fees below:

Provide a breakdown of professional fees earned for the last 12 months:

Please complete the following Professional Indemnity related questions:

Has the practice or any related entity ever engaged in or had a share of an entity engaged in:

Express as a percentage, the practice’s professional fees derived from the following activities:

Express as a percentage, the approximate work undertaken in the following areas:

Please complete the following Management Liability related fields:

Please complete the following Construction Insurance related fields:

Please advise if you are interested in obtaining details regarding the following insurance products to further protect your business:

Please provide any supporting documents:

Declaration