Insurance Australia - Public Liability & Indemnity for the Mining Industry, Equine Activities and Retail Insurance offered byHigh Street Underwriting Agency, Brisbane Australia
Quote Form for Mining Insurance
Quote Form for Mining Insurance, Equine Insurance -  Liability & Indemnity Insurance
Mining Liability Insurance quotation form
Mining Insurance Australia - Public Liability Indemnity Insurance offered by High Street Underwriting Agency Brisbane Australia High Street Underwriting Agency, Cairns Australia Insurance Australia - Public Liability & Indemnity for the Mining Industry, Equine Activities and Retail Insurance Insurance Australia - Public Liability and Indemnity Insurance for the Mining Industry, Equine Activities and Retail Insurance

 
Quote Questionnaire On-Line Form


For a MINING LIABILITY INSURANCE quotation, please complete the ON-LINE FORM below and click on SUBMIT.

TO BE COMPLETED BY AUSTRALIAN CLIENTS ONLY

 
ON-LINE QUOTE QUESTIONNAIRE FORM
 
 

CONTACT DETAILS
BUSINESS NAME:
PHONE NO.:
FAX NO.:
CONTACT PERSON:
EMAIL ADDRESS:
 

BUSINESS DETAILS
FULL BUSINESS DESCRIPTION
OF ALL ACTIVITIES:
HAVE YOU OR WILL YOU
SIGN A CONTRACT WITH THE MINE:
(If so, we will need a copy of the
Insurance Section to enable us
to provide you with the correct cover.)

YES

NO
NUMBER OF YEARS EXPERIENCE
IN THIS INDUSTRY:
ESTIMATED ANNUAL TURNOVER
FOR THE NEXT 12 MONTHS:
HAVE YOU HAD ANY CLAIMS
IN THE LAST 3 YEARS?:

YES

NO
DO YOU MANUFACTURE, SUPPLY, DISTRIBUTE OR SELL PRODUCTS?

YES

NO
IF YES, PLEASE PROVIDE FULL DETAILS OF PRODUCTS AND ESTIMATED
TURNOVER FROM PRODUCT SALES
FOR THE NEXT 12 MONTHS:
 

PUBLIC LIABILITY QUOTE
AMOUNT OF PUBLIC LIABILITY COVER:
$10,000,000
$20,000,000

OTHER $:
 

PROFESSIONAL INDEMNITY QUOTE
(cover for advice given)
ESTIMATED ANNUAL GROSS FEE CHARGED
FOR ONLY ADVICE GIVEN:
AMOUNT OF PROFESSIONAL INDEMNITY COVER:
$5,000,000
$10,000,000

OTHER $:
 
 


THANK YOU!

 
High Street Underwriting Agency - Insurance for the Mining industry, Equine Avtivities and Retail Insurance - Public Liability & Indemnity Insurance, commercial Property, General insurance






 

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