Business Combined Insurance - Liability Client Code*Name of person completing questionnaire*Insured Name*Business Combined Insurance1. Are there any changes in your business activities / operations?* Yes No If YES, please advise full details2. Have there been any material changes to fire and theft protection alarms, devices and the like during the past 12 months? (e.g. disconnection or dismantling or installation of any services)* Yes No If YES, please advise full details3. Is there any history of flood damage at the insured location(s)?* Yes No If YES, please advise full details4. Is there any history of flood damage at any of your key suppliers' premises?* Yes No If YES, please advise full details5. Is there any history of flood damage at any trade show or exhibition ground where you display goods?* Yes No If YES, please advise full detailsLiability6. Estimated Turnover for the forthcoming year ($)*7. Number of principals*8. Number of staff*9. Estimated Payroll ($)*10. Are Contractors/Sub-contractors used?* Yes No Activities performed*Estimated Annual Payments made: $*Do you sight current Public Liability insurance prior to work commencing?* Yes No 11. Are Labour Hire personnel used?* Yes No Activities performed*Estimated Annual Payments made: $*Do you sight current Public Liability insurance prior to work commencing?* Yes No 12. Any demolition activities* Yes No 13. Does demolition exceed 3.5 metres in height?* Yes No if YES, state the maximum height (m) and percentage of turnover (%)14. Do you Dry Hire? (Hire out plant without an operator)* Yes No 15. Do you use, handle or store explosives?* Yes No 16. Do you handle, treat remove or transport any asbestos?* Yes No 17. Please provide a description of your business activities to ensure your Public Liability cover is sufficient*Other Insurances18. Are there any other insurance needs e.g. Insurance of Income, Home, Contents, Motor Vehicle, Caravan, Boat etc, with which we can assist?*Claims19. Details of any claims that have occurred, but have not yet been reported*20. After specific inquiry, details of any facts, circumstances or incidents (other than those already disclosed, notified to your insurer) which could give rise to a future claim*Office Message RecipientSelect the office you want to which you wish to send your message* Maroochydore Townsville Proserpine Mackay Ingham All changes or inclusions of any sort or type, including limits or sums insured shown, will take effect from the policy's expiry date unless you request otherwise.Information we have provided to Steel Pacific Insurance Brokers, is to the best of our knowledge correct. Please type your name below:*CommentsThis field is for validation purposes and should be left unchanged.Δ