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Sunshine Coast 1800 072 114 | Central Queensland 1800 961 007 | North Queensland 1800 629 701

Steel Pacific Insurance Brokers

The Steel family established Pacific Insurance Brokers in 1982, opening offices in both the Solomon Islands and Vanuatu.

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Business Combined Insurance

Business Combined Insurance

Client Code*
Name of person completing questionnaire*
Insured Name*
1. Are there any changes in your business activities / operations?*
- Yes
- No
If YES, please advise full details
2. Have there been any material changes to fire and theft protection alarms, devices and the like during the past 12 months?*
- Yes
- No
(e.g. disconnection or dismantling or installation of any services)
If YES, please advise full details
3. Is there any history of flood damage at the insured location(s)?*
- Yes
- No
If YES, please advise full details
4. Attached to your email is a summary of your existing cover for review. Please advise if changes are required.*
- Yes
- No
If 'YES', please advise changes below
5. Declared Replacement Values : please update the values shown in the Schedule of Insurance
Other Insurances
Are there any other insurance needs e.g. Insurance of Income, Home, Contents, Motor Vehicle, Caravan, Boat etc, with which we can assist?*
- Yes
- No
Claims
1. Details of any claims that have occurred, but have not yet been reported*
2. 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 Recipient
Select the office you want to which you wish to send your message*
- Maroochydore
- Townsville
- Proserpine
- Mackay
- Ingham
Information we have provided to Steel Pacific Insurance Brokers, is to the best of our knowledge correct.
Name
This field is for validation purposes and should be left unchanged.

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Steel Pacific Insurance Brokers

Experience the Difference

Sunshine Coast
1800 072 114

Central Queensland
1800 961 007

North Queensland
1800 629 701

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Ballyglisheen Pty Ltd trading as Steel Pacific Insurance Brokers
ABN 47 075 780 353
AFSL 230634

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