Skip to content

Client Login

Main menu

About Us
Services
Policies
Claims
News
Forms
Contact

1800 078 078

Get a Quote

IT Professional | PI & Liability Quote Form

Details
Professional Indemnity
Additional Services
Public Liability
General information

Employees (Business owner included)

Estimated Annual Revenue (Australian Dollars)

$

Street Address

Email address

First name

Last name

Phone Number

Start date of Insurance:

What level of Professional Indemnity cover do you require?

$1M

$2M

$5M

$10M

$20M

As at today's date does the insured have Professional Indemnity Insurance currently in force that has been paid for?

Yes

No

Please specify your revenue by business activity:

Please note: Total Sum Must be at 100%

The provision of Information Technology services

ISP / Web Hosting / Internet Services

Telecommunication Services

Application Service Provider

Software Application and Development / Programming

Software Sales (Own Developed)

Software Sales - Packaged Third Party

Software Maintenance

Website Design and Development

Software Installation

Hardware Sales

Hardware Installation, Maintenance, Repair and Engineering

Ecommerce Application Development

Database Programming and Applications

Systems Integration

Data Processing and Warehousing

Does the Insured perform any work in relation to the following:

Medical/Surgical applications

Yes No

Aerospace/Radar/Navigation Systems

Yes No

Military/Defence Systems

Yes No

Oil, Gas, Power, Nuclear Energy applications

Yes No

Financial or Banking Systems that support Share Trading, Financial Transactions or Financial Calculations

Yes No

Process Control Systems

Yes No

Security Systems

Yes No

Console, Mobile or PC games

Yes No

Does the Insured provide any Software Development or System Integration Services?

Yes No

In the last 10 years, have any claims for a breach of professional duty been made against the Business, it's predecessors in business or it's current or former partners/principals/directors or employees?

Yes No

What level of Public Liability cover do you require?

$1M

$2M

$5M

$10M

$20M

Does the insured perform any repair, maintenance or cabling activities?

Yes No

Does Your Business engage or intend to engage non-clerical contractors, subcontractors, or staff from labour hire firms to perform work under the sole or partial direction of You?

Yes No

Does the business directly import raw materials, components or finished goods?

Yes No

Does the insured perform any repair, maintenance orWould you like to note your landlord as an interested party on your Public Liability policy? cabling activities?

Yes No

Had any business insurance/liability claims?

Yes No

Had any insurance declined or cancelled?

Yes No

Suffered any loss or damage which would have been covered by the proposed insurance policy?

Yes No

Been convicted of any criminal offence?

Yes No

Been liable for any civil offence or pecuniary penalties?

Yes No

Been declared bankrupt or involved in a business which became insolvent?