Professional Indemnity Enquiry

Please complete the form below and we will be quick to reply with your quote.

Contact Details
Proposed Insured (i.e Company Name, Sole Trader, etc):*
ABN
Name
First Last
Phone
Email
Business address
Address line 1 Address line 2 Town/suburb State Postcode
Website
Business Information
Business / Profession
Services Provided and % of income
Service Percentage
Business Turnover last 12 months
If you are a new business, please provide forecast turnover for the next 12 months
Do you provide services overseas
- Yes
- No
Please provide details of the services you provide overseas
Numbers of Directors / Partners
Number of Employees
Number of Contractors / Consultants
Professional Memberships
Have you had any previous / current professional indemnity claims
- Yes
- No
Please provide details of claims
Insurance
Required Indemnity Limit*
Preferred Excess*
Proposed policy start date*
Date Format: DD slash MM slash YYYY
Would you like to disclose anything else that is particular to your business risk?
Other Insurance Requirements: (i.e Public Liability, Management Liability, Property, Cyber Crime, etc)
Do you have any particular questions that you would like to ask?

Hi David,
I have to congratulate you on making this such an awesomely easy process.
This is the way cloud technology should be used, a win-win for both parties.
Excellent! Love it!

Ed Henry

Director - Sage Australia Pty Ltd

Professional Indemnity Enquiry

Contact Details

Business Information

Insurance

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Service	Percentage