Real Estate Agents
Advice Line
1300 464 989
1
2
3
4
5
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Real Estate Agents
Advice Line
1300 464 989
1
2
3
4
5
6
Completing this online Proposal Form
Please answer all questions giving full and complete answers.
It is the duty of the proposer to provide all information that is requested in this Proposal Form as well as to disclose relevant facts. A relevant fact is a known fact or circumstances that may influence the evaluation of risk by the insurer. If you are uncertain about what a relevant fact is, please contact us.
If renewing an existing policy with Express Insurance, please ensure you check all information and make any necessary changes.
Business Details
Income Details
Total Annual Income
$
Employee Numbers
Do you employ staff (excluding yourself)?
Yes
No
Please state the total number of staff including yourself:
Do you employ or intend to employ sub-contractors?
Yes
No
Enter Total Annual Payment made to sub-contractors
$
Business Activity Analysis
Total must be 100%:
Residential Sales
%
Property Development
%
Commercial Sales
%
Mortgage and Finance Broking
%
Rural Sales
%
Project Development
%
Auctioneering
%
Insurance / Financial Institutions Agency
%
Stock and Station Agent
%
Land / Business Broking
%
Residential Property and Strata Management
%
Buyers Advocacy
%
Commercial Property and Strata Management
%
Valuations
%
Real Estate Sales - Off the Plan Non CBD
%
Other
%
Real Estate Sales - Off the Plan CBD
%
Please provide details of "Other" Activities
Does your Commercial Property & Strata Management Include shopping centres?
Yes
No
Do you require Fidelity Cover?
Yes
No
Fidelity cover will only be provided if the answer to the following question is Yes.
Do you segregate duties so that no one person can request or authorise expenditure or refunds or reconcile bank statements?
Yes
No
In respect of Total Annual Income, please provide a breakdown by State:
Total must be 100%:
NSW
ACT
QLD
VIC
TAS
SA
WA
NT
Overseas
Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?
Yes
No
Period of Insurance
Policy Start Date
Promotional Code (if relevant)
