• Full legal name of each natural person or incorporated body to be insured as well as any unincorporated business names.
  • Contact/Business Owner Details

  • Date Format: DD slash MM slash YYYY
  • Business Details

  • Please enter a number from 0 to 99.
  • Please enter a number from 0 to 10.
  • Income

  • Please show the % split between states below.
  • If overseas, please state countries
  • Your Duty of Disclosure

    You have a duty under the Insurance Contracts Act 1984 (Cth) to disclose to the Insurer anything that You could reasonably be expected to know is relevant to their decision whether to accept the risk of insurance and if so, on what terms. You have the same duty to disclose those matters to the Insurer before You renew, extend, vary or reinstate a contract of general insurance. Your duty however does not require disclosure of a matter: • that diminishes the risk to be undertaken by the Insurer; • that is of common knowledge; • that the Insurer knows or, in the ordinary course of business, ought to know; or • as to which compliance with Your duty is waived by the Insurer. The duty of disclosure applies to You and everyone insured under the contract of insurance. If You, or they, fail to comply with the duty of disclosure, the Insurer may reduce their liability under the contract in respect of a claim. If the non-disclosure is fraudulent, they may treat the Policy as if it never existed and pay nothing. It is important that all information provided in support of Your application for insurance is understood by You and is correct, as You will be bound by Your answers and by the information provided by You. If You do not understand any part of this notice, you should contact us. Your duty of disclosure continues after Your application for insurance has been completed up until the contract of insurance is entered into.
  • Disclosure Questions

    Please answer the following questions in accordance with Your Duty of Disclosure above.
  • Declaration

    I / We declare and acknowledge that: • I / We have made due inquiry of the Applicant and its Principals, Partners, Directors and Employees concerning the questions asked within this Proposal and have authority to sign this Proposal on their behalf; • I / We have read and understood the Duty of Disclosure - Important Information Section of this Proposal; • The statements and particulars in this Proposal are true and correct; • This Proposal along with any other information supplied by Me /Us shall form the basis of any Policy entered into; • I / We understand that up until the Policy is entered into, We must notify any change in the matters disclosed in this Proposal; and • I / We will notify any material alteration to the matters disclosed in this Proposal occurring after completion of the Proposal.