Locksmith Application Form

Can I start with your personal Details?

Nice to meet you! Please tell about your Business

Tell us more about your Business

1. You carried on a business in the income year (the previous year) before the current year and the aggregated turnover for the previous year was less than $2m;
2. The aggregated turnover for the current year is likely to be less than $2m.

Great! List your limits of Indemnity

Have You or any director or partner involved with the Business or any other business have in the past 5 years

Provide your Claim History - Professional Indemnity and Liability

After investigation, is the proposer or any principal, partner, or director aware:

• acts, errors or omissions that occurred prior to the retroactive date (if one or more is specified) in the policy;
• any claim made, threatened or intimated against you prior to the commencement of the policy period;
• any claim or fact that might give rise to a claim, reported or which can be reported to an insurer under any insurance policy entered into before the commencement of the policy period;
• any claim or fact that might give rise to a claim, noted in this proposal or any previous proposal;
• any claim arising out of any fact you are aware of before the commencement of the policy period;
• any claim made against you after the expiry of the policy period.

However, the effect of Section 40(3) of the Insurance Contracts Act 1984 (Cth) is that where you become aware, and notify us in writing as soon as is reasonably practicable after first becoming aware but within the policy period, of any facts which might give rise to a claim against you, any claim which does arise out of such facts shall be deemed to have been made during the policy period, notwithstanding that the claim was made against you after the expiry of the policy period.

Privacy

We are committed to protecting your privacy. We use the information you provide to us to arrange for and quote on the financial services we provide to you. We only provide personal information to the financial service providers (and their representatives) and those appointed to assist you with claims under policies of insurance. We will not trade, rent, or sell the information.

If you do not provide us with full information, we cannot properly quote / arrange your financial products and provide the service you expect. You can check the personal information we hold about you at any time. For more information about our Privacy Policy Statement, ask us for a copy.

Duty of Disclosure

The law requires you to tell us everything you know (or could reasonably be expected to know in the circumstances) which is relevant to our decision to insure you and the terms on which we insure you. This duty applies before you enter into a contract with us, that is, before we accept your proposal and also each time before you alter or renew the Policy. Each person named as the Insured has the same duty.

Penalty for Non-Disclosure

If you do not tell us everything necessary, we may: reduce or refuse to pay a claim; or cancel your Policy. If you act dishonestly, we may invalidate the Policy from its beginning and not be bound by it.

You don’t need to tell us anything which: reduces the risk; is common knowledge; we already know or ought to know in the ordinary course of our business; or we indicate we do not want to know. If you are not sure that something is relevant, it is best to disclose it anyway.

Declaration and Signature

1. The Duty of Disclosure, Non-Disclosure and Inadequate Space to Answer notices set out above have been read by me/us.
2. All answers and statements made in this application are true and accurate in every respect and no information has been withheld which is likely to affect your decision about accepting this insurance.
3. I acknowledge you reserve the right to decline any application.
4. I acknowledge that you may market