Business Combined Insurance - BI, Liability & Machinery Client Code*Name of person completing questionnaire*Insured Name*Business Combined Insurance1. Are there any changes in your business activities / operations?* Yes No If YES, please advise full details2. 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 full details3. Is there any history of flood damage at the insured location(s)?* Yes No If YES, please advise full details4. Is there any history of flood damage at any of your key suppliers' premises?* Yes No If YES, please advise full details5. Is there any history of flood damage at any trade show or exhibition ground where you display goods?* Yes No If YES, please advise full detailsBusiness Interruption/Loss of EarningsThe policy is designed to protect loss of earnings and it is important to adjust Business Interruption values at each renewal.The following formula will be of help in calculating appropriate values for the forthcoming year.Estimated Sales ($)Less ( - ) Purchases (Cost of goods $) Equals ( = ) Insurable Gross ProfitORGross Rental Income for next 12 months (including special outgoings $)Select your calculation method* Estimated Sales Gross Rental Income Estimated Sales*Minus Purchases (Cost of goods)*Equals Insurable Gross Profit*Gross Rental Income for next 12 months (including special outgoings $)*6. Do you require quotes for Rent Default?* Yes No 7. Do you require quotes for Eviction Costs?* Yes No Liability8. Estimated turnover for the forthcoming year ($)*9. Number of principles*10. Number of staff*11. Estimated payroll ($)*12. Are Contractors/Sub-contractors used?* Yes No Activities performed*Estimated Annual Payments made: $*Do you sight current Public Liability insurance prior to work commencing?* Yes No 13. Are Labour Hire personnel used?* Yes No Activities performed*Estimated Annual Payments made: $*Do you sight current Public Liability insurance prior to work commencing?* Yes No 14. Any demolition activities* Yes No Does demolition exceed 3.5 metres in height?* Yes No If YES, please state the maximum height (m) and percentage of turnover (%)15. Do you Dry Hire? (Hire out plant without an operator)* Yes No 16. Do you use, handle or store explosives* Yes No 17. Do you handle, treat remove or transport any asbestos?* Yes No 18. Please provide a description of your business activities to ensure your Public Liability cover is sufficient*Machinery Breakdown19. The level of cover and sums insured must be reviewed to ensure they are adequate and continue to meet your requirements. Please advise any changes that are required*20. Have you purchased any machinery / equipment in the last policy period?* Yes No If YES, please advise full detailsOther Insurances21. Are there any other insurance needs e.g. Insurance of Income, Home, Contents, Motor Vehicle, Caravan, Boat etc, with which we can assist?*Claims22. Details of any claims that have occurred, but have not yet been reported*23. 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*All changes or inclusions of any sort or type, including limits or sums insured shown, will take effect from the policy's expiry date unless you request otherwise.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:* PhoneThis field is for validation purposes and should be left unchanged.Δ