INSURANCE DOESN’T HAVE TO BE COMPLICATED

AMC INSURANCE PTY LTD

Commercial Property Owner Insurance Quote Application Form

DUTY OF DISCLOSURE

Before you enter into a contract of general insurance with an insurer, you have a duty under the “Insurance Contracts Act 1984”, to disclose to the insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer’s decision whether to accept the risk of the 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 common knowledge; that your insurer knows, or in the ordinary course of business, ought to know; as to which compliance with your duty is waived by the insurer. Anybody who is an insured under your policy must comply with the duty of disclosure. Make sure you explain the duty to any other parties to be insured you may apply on behalf of.

Commercial Property Owner Insurance Quote Application Form

Phone

This field is for validation purposes and should be left unchanged.

Contact Information

Contact Person Name(Required)

First Last

Postal Address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

Note this is your address and not the address of the property to be insured (if different). All communications will be sent via email.

Email Address(Required)

Email Address Confirm Email Address

Phone(Required)

Wesbite (if applicable)

Insured Details

Please provide information on the person and/or company to be insured.

Insured Name (e.g. Your Name, Company Name)(Required)

Only the names listed as an insured on the policy will be covered.

ABN (if applicable)

Are you registered for GST?

YES

Please provide details of any Interested Party if required (e.g. Bank)

Details of Property to be Insured

Note our form is currently design to enter details for a single property only. If you have multiple properties to be insured please submit additional forms for each property - or contact us to discuss.

Full Address of Location to be Insured(Required)

Please include State/Territory/Postcode.

What best describes the nature of the building usage?(Required)

Office (Only)

Office & Retail

Retail (Only)

Factory/Manufacturing/Warehousing

Other

Please describe the other use of the building.(Required)

Does the building have any residential use?(Required)

YES

What percentage (%) of the property floor space is for residential usage?(Required)

Is the building part of a strata?(Required)

YES

How many storeys does the building have?(Required)

What year was the building first built?(Required)

If unsure of exact year please note approximate decade (e.g. 1970s).

Is the property more than 30 years old?(Required)

YES

What year was the wiring and switchboard last replaced?(Required)

If not applicable/available please mark as "N/A".

What year was the wiring last certified as compliant by a qualified electrician?(Required)

If not applicable/available please mark as "N/A".

What year was the last thermographic scan carried out with no faults recorded?(Required)

If not applicable/available please mark as "N/A".

What year was the plumbing last serviced or inspected by a qualified plumber?(Required)

If not applicable/available please mark as "N/A".

What is the primary construction of the building's external walls?(Required)

Brick/Concrete

Timber

Metal

Fibro/Asbestos

Other

Walls are mixed construction (e.g. Brick, Concrete, Metal)

Please describe primary construction of the building's external walls.(Required)

Please describe approx. % splits of construction of walls (e.g. 70% Brick, 30% Weatherboard)(Required)

Are there any EPS (expanded polystyrene) insulated panel walls?(Required)

YES

What is the approx. % of floor area that contains EPS (expanded polystyrene) insulated panel walls?(Required)

Are the EPS (expanded polystyrene) walls:(Required)

Internal

Extenal

Both (Internal/External)

Is there a current self inspection programme in place for the EPS (expanded polystyrene) walls?(Required)

YES

What is the primary construction of the building's roof?(Required)

Concrete

Timber

Metal

Other

Please describe primary construction of the building's roof.(Required)

What is the primary construction of the building's floor?(Required)

Concrete

Timber

Other

Floors are mixed construction (e.g. Concrete, Wood)

Please describe primary construction of the building's floor.(Required)

Please describe approx. % splits of construction of floors (e.g. 70% Concrete, 30% Timber)(Required)

Does the property have any asbestos?(Required)

YES

Where is the asbestos located?(Required)

Roof only

Walls only

Both (Roof and Walls)

What approx. % of the property has asbestos?(Required)

Does the premises contain any Aluminium Composite Panel?(Required)

YES

What approx. % of the property has Aluminium Composite Panel?(Required)

Has the roof been replaced or improved since the premises were built?(Required)

YES

Please specify the year the roof was replaced or improved(Required)

Declared Insured Values Required

Please provide details of full replacement values and sums insured required.

Building Sum Insured ($)(Required)

Landlords Fixtures and Fittings ($)

All Other Property ($)

Loss of Annual Rent ($)

Do you need cover for Theft of your Landlords Fixtures and Fittings?(Required)

YES

Theft Sum Insured ($)(Required)

Do you need cover for Glass?(Required)

YES

What level of Glass cover do you need?(Required)

External Glass Only

External & Internal Glass

Do you need cover for Glass/Plastic Signs?(Required)

YES

Total sum insured required for signs ($)(Required)

Is Machinery Breakdown Cover Required?(Required)

YES

What Sum Insured do you require for Breakdown of Air-Conditioning, Electronic Motors, Ventilations and Exhaust Systems ($)?(Required)

What Sum Insured do you require for other Breakdown e.g. Boilers ($)

Do you require Property Owners Liability cover?(Required)

YES

What Sum Insured for Property Owners Liability is required?(Required)

$5,000,000

$10,000,000

$20,000,000

Additional Risk Protection Infromation

This information will help assist insurers in considering whether to accept your risk and on what basis.

Fire & Security Protection - which of the following does your premises have installed:(Required)

Please only tick those that apply.

What is the frequency of fire protection equipment service? (e.g., biannually)(Required)

What was the date of last fire protection servicing(Required)

Please describe other protections in place at the premises(Required)

Tenant and Operations Risk Information

This information will help assist insurers in considering whether to accept your risk and on what basis.

What is the risk exposure for your premises?(Required)

Single Tenant

Multi Tenant

What is the business name of the tenant and their occupation/industry?(Required)

Please list the business names and relevant occupation/industry for each tenant in full below(Required)

Are any of your tenancies currently vacant?(Required)

YES

Please provide full details of how many vacant tenancies there are any what approx. % of floor space is unoccupied(Required)

Is there any cooking onsite at the premises?(Required)

YES

Are fire blankets installed in the kitchen/cooking areas?(Required)

YES

Are a minimum of 2 x 4.5kg dry or wet chemical fire extinguishers installed in kitchen?(Required)

YES

Please tick all methods of cooking/type that are conducted onsite at the premsies(Required)

Natural Gas

LPG

Deep Fryers

Woks

Electric

Stoves/Ovens

Hot Plates/Grills

Salamanders

Other

What is the number of deep fryers and total combined volume of deep fryers(Required)

Are all deep fryers thermostatically controlled with automatic cut-off switches?(Required)

YES

Frequency of cleaning filters(Required)

Weekly

Fortnightly

Monthly

Other

What is the frequency of cleaning filters?(Required)

Frequency of cleaning canopies(Required)

Weekly

Fortnightly

Monthly

Other

What is the frequency of cleaning canopies?(Required)

Filter and canopy cleaning is carried out by(Required)

Staff

Professional Contractors

Name of contractor used for filter and canopy cleaning:(Required)

Frequency of cleaning ducting/flues(Required)

Fortnightly

3 monthly

Annually

Ducting and flues cleaning is carried out by(Required)

Staff

Professional Contractors

Name of contractor used for ducting and flues cleaning:(Required)

Is there any woodworking on the site?(Required)

YES

What woodworking processes are used on the site?(Required)

Cutting/Sanding

Upholstery

Varnishing/Painting/Lacquering/Spray Painting/Adhesive Application

Please tick all that apply.

Floors and machinery cleaned(Required)

Daily

Weekly

Other

Please describe frequency of cleaning floors and machinery(Required)

How often are the Roof Frame and Walls cleaned?(Required)

Waste and Off-cuts removed from site(Required)

Daily

Weekly

Other

Please describe frequency of waste and off cuts removed from site(Required)

Is there any dust accumulation in the premises, especially on horizontal services?(Required)

YES

Oily rags disposed of in a self-closing metal bin(Required)

YES

What type of dust extraction systems are used at the premises?(Required)

None installed

Ducted system to central internal hopper

Portable/mobile bag system

Ducted/fixed system to external hopper

Does the premises have a vented spray booth?(Required)

YES

Are the light fittings in the spray booth enclosed?(Required)

YES

Is it compliant with Australian Standards?(Required)

YES

Percentage of the floor area taken up by the spray booth in sqm(Required)

Describe the construction of the spray booth (EPS, etc)(Required)

How often are the filters cleaned?(Required)

Please describe.

Open-air spray/coating operations(Required)

YES

Heating drying tunnels/ovens(Required)

YES

Please describe rules on smoking on-site:

No smoking allowed

Permitted without restriction

Designated external areas only

Designated internal areas of the building

Claims History & Disclosure

Please confirm the following disclosure and claims information.

Have you or any director/partner/manager of the business/ownership of property ever:(Required)

Had insurance declined or cancelled?

Had an insurer refuse or not invite renewal?

Had any special conditions imposed on a policy of insurance?

Had a special excess imposed on a policy of insurance?

Had a claim rejected under a policy of insurance?

Been declared bankrupt or put into receivership or liquidation?

Been charged with or convicted of a criminal offence?

Please tick ALL that apply.

Please provide full details of matters relating to director/partner/manager disclosure:(Required)

Have you claimed on an insurance policy or had any uninsured losses in respect of the covers proposed?(Required)

YES

Please provide full details of each past claims and/or losses including approx. dates, value of loss and description(Required)

Current Insurance Information

Please provide the following details to assist our review of the insurers we approach.

Is the property currently insured?(Required)

YES

What date do you expect to require cover to start from?

Please note we are unable to backdate cover with insurers.

What date did you purchase the property and/or expect to purchase the property?(Required)

What is your current expiry date?(Required)

Who is your current insurer?(Required)

Please note we are unable to approach your current insurer without your explicit authority; confirm your current insurer so we do not approach them in error.

If you would like to provide your current premium please do so below ($).

Total premium is inclusive of all charges: insurer premium, GST, Stamp Duty, Fire Services Levy, Broker Fees, etc.

Would you like to upload details of your current insurance policy so that we can review covers against the insurers we approach?(Required)

YES

Please upload your current/expiring policy schedule.(Required)

Accepted file types: jpg, png, jpeg, pdf, Max. file size: 512 MB.

Is there any other informaiton or notes that you would like to provide?

YES

Please provide further information or notes as requested.