Engineering – Machinery Breakdown Insurance Client Code*Name of person completing questionnaire*Insured Name*1. Have you purchased any machinery / equipment in the last policy period?* Yes No If YES, please advise full details.If you require any assistance or wish to discuss any element of the policy please contact us as we will assist you wherever possible.Claims2. Details of any claims that have occurred, but have not yet been reported*3. After specific inquiry, details of any facts, circumstances or incidents (other than those already disclosed, notified to your insurer) which could give rise to claims in the future.*Office Message RecipientSelect 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. Please type your name below:* NameThis field is for validation purposes and should be left unchanged.Δ