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OB Personal Accident & Volunteer Workers Insurance Quote

Please fill in all "Mandatory Field" sections and provide as many details as possible to speed up the processing of your request. You will receive a reply within two business working days!!

 
First Name:
  *
Last Name:
  *
Fax:
Phone:
  *
Email:
  *
Postal Address - Street Address:
  *
Suburb:
  *
Post Code:
  *
State:
  *
Site Address same as Postal Address:
  *
Site Street Address:
Site Suburb:
Site Post code:
Site State:
Project Type:
  *
Workers to cover:
  *
Number of workers at anytime:
  *
Estimated replacement current cost of work ($):
  *
Insurance From Date:
  *
Insurance End Date:
  *
Have you ever made an insurance claim under any accident or sickness or travel policy?:
  *
If you answered 'Yes' above, please provide details::
Help us help you by answering this survey question:
What type of roof do you have?:
  *
Under the Insurance Contracts Act 1984 (the Act), you have a Duty of Disclosure. To disclose to the insurer every matter you know, or could reasonably be expected to know, is relevant to the insurers 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 enter into, renew, vary, extend or reinstate a contract of general insurance. If you fail to comply with your Duty of Disclosure the insurer may be entitled to reduce its liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent we may treat this Policy as never having worked.
Declaration:
I / We confirm that the answers and statements in this proposal are correct and that no information has been supplied or withheld in breach of the duty of disclosure which is set out above, nor have I/We misrepresented any information supplied to you which could affect your acceptance of this proposal or the terms of the policy. I acknowledge that the insurer will have no liability whatsoever until it accepts this application by issuing a Policy Schedule/Certificate and that the insured person's duty to disclose any matter material to the insurers decision whether to issue a Policy and what terms and conditions to offer until the insured has issued the Policy Schedule/Certificate.
  *
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