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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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Industrial Special Risks Insurance Renewal

Industrial Special Risks Insurance Renewal

Client Code:*
Name of person completing questionnaire:*
Insured Name:*
1) The following entities are Named Insured under the Policy:*
2) Are any changes required?*
- Yes
- No
If YES, please advise details
3) Is there any change in your business activities or operations?*
- Yes
- No
If YES, please advise details
4) 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 details
5) Is there any history of flood damage at
6) The insured location(s)?*
- Yes
- No
7) Any of your key suppliers' premises?*
- Yes
- No
8) Any trade show or exhibition ground where you display goods*
- Yes
- No
9) Investment or Rent Producing Properties*
- Yes
- No
10) Estimated Rental Income (including recoverable outgoings) ($)*
11) What time period would be required to fully re-build the premises? (months)*
12) For disclosure purposes, please provide details of each tenant, its activities and the address of the property*
13) Unoccupied Properties - please advise of any un-occupied properties*
Consequential Loss - Business Interruption - Loss of Trading Income
14) The Indemnity Period under your policy is 12 months. Is this sufficient time for you to re-build the damaged property; restore operations and/or re-capture market share?*
- Yes
- No
If not, what period would be required? (months)
Claims
15) Details of any claims that have occurred, but have not yet been reported*
16) 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 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. Please type your name below:*
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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