Recruitment Consultants
Advice Line
1300 464 989
1
2
3
4
5
6
Recruitment Consultants
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
$
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
Business Activity Analysis
No
Yes
Do you require cover in relation to onhired (temporary) employees/contractors?
Type of cover:
Vicarious Liability Cover Only
Vicarious Liability Cover and Cover to the onhired (temporary) employee/contractors
Total must be 100%:
Total Fees % Split
Permanent Placements
On-Hired (Temp) Employees/Contractors
Clerical/Secretarial
%
%
Accountants
%
%
Architects
%
%
IT Consultants
%
%
HR Consultants
%
%
Bookkeepers
%
%
Management Consultants
%
%
Marketing Consultants
%
%
Blue Collar Workers
%
%
Medical Practitioners
%
%
Nurses/Healthcare Workers
%
%
Engineers
%
%
Other
%
%
Please provide further details
Period of Insurance
Policy Start Date
Promotional Code (if relevant)
