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Locksmith Application Form

You are here: Home / Locksmith Application Form

Step 1 of 8 - Personal Details

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  • Can I start with your personal Details?

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    Contact Details

  • Nice to meet you! Please tell about your Business

  • Business Details

  • Street Address

  • Tell us more about your Business

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    Business Information

  • (e.g. Directors / Employees / Labour Only Sub Contractors / Work Experience)
  • Turnover Split By State

  • Must equal 100%
  • Note, a small business under the changes relating to the NSW Stamp Duty exemption defines that a business is a small business for an income year (the current year) if: You carry on a business in the current year; and One or both of the following applies:
    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.
    For more information, visit: https://www.revenue.nsw.gov.au/taxes-duties-levies-royalties/insurance-duty/exemptions
  • Great! List your limits of Indemnity

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    Limits of Indemnity

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

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    General Details

  • Provide your Claim History - Professional Indemnity and Liability

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    Claim History - Professional Indemnity & Liability

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

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    General Information

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    Claim made Policy

  • This means that the policy applies to claims made against you and notified to the insurer during the policy period. The policy does not provide cover in relation to:
    • 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
  • This field is for validation purposes and should be left unchanged.

Wymark Insurance Brokers - Melbourne / Wollongong

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Wymark Insurance Brokers - Wollongong

Level 1 17 Flinders Street, Wollongong, NSW 2500

02 4202 6174

Wymark Insurance Brokers - Melbourne

10/758 Blackburn Road, Clayton, VIC 3168

1300 797 830
03 8566 7247

Wymark Insurance Brokers (Melb) Pty Ltd T/as Wymark Specialty | ABN: 88 627 915 039 is a Corporate Authorised Representative No. 001282067 of Aviso Select Pty Ltd T/As Aviso Select | ABN: 45 001 366 847 | AFSL No: 239049

Wymark Insurance Brokers (Melb) Pty Ltd ABN: 88 627 915 039 is a Corporate Authorised Representative No. 001282067 of Wymark Insurance Brokers Pty Ltd ABN: 11 010 863 966 AFSL: 238769.

AFS Brokers Pty Ltd T/as Wymark Insurance Brokers Wollongong | ABN: 42122949044 is a Corporate Authorised Representative No. 001282067 of Aviso Select Pty Ltd T/As Aviso Select | ABN: 45 001 366 847 | AFSL No: 239049

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