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

First Name

Last Name

Phone

Business address

Address line 1

Town/suburb

State

Postcode

Website

Business Information

Business / Profession

Website

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

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?

Email address