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You can either submit your request via our online quote or contact us by phone, fax or email anytime.  

(W) 03 9578-0917 (F) 03 9578-2090 Email: rob@pibins.com.au

 



1. Business Details

1a. Business Name :

1b. Business Address :

1c. Type of Business :

1d. Number of Staff :

1e. Annual Wages Paid :

1f. Gross Turnover/Annum :

1g. Building occupied by :

1h. Period occupied by proposer :

1i. Period in this type of business :

2. Fire Insurance Details

2a. Age of Building :

Building has been rewired (if over 40 years old) :

2c. Height of building :

2d. Approx. Area :

2e. Condition of Building :

2f. Value of contents :

Fire Protection

2g. Single Sprinklers :

2h. Dual Sprinklers :

2i. Water Hydrant :

2j. Extinguishers :

2k. Vats :

Goods Protection

2l. Goods in open air :

2m. Customers work in Progress :

3. Seasonal Stock

3a. Cover Amount :

3b. Period Required :

3c. Extra cost of re-installment :

4. Premises Details

Walls

4a. Block/Brick :

4b. Timber :

4c. Iron :

4d. Fibro :

4e. Other :

4f. Roof :

4g. Other :

4h. Floors :

4i. Other :

5. Burgalry insurance Details

5a. Alarm :

5b. Alarm Connection :

Sensors

5c. Infra Red :

5d. Glass Breakage Detector :

Deadlocks :

5e. All Doors :

5f. Other :

5g. Other Burglary details :

5h. Made a claim in the last 5 years :

5i. Details :

5j. Have you ever had any insurance cancelled or declined :

5k. Have you ever been charged or convicted of any criminal offence or declared bankrupt?

6. Insurance Amounts :

Fire and Accidental Damage

6a. Building :

6b. Stock :

6c. Other Contents :

6d. Removal of Debris :

6e. Loss of rent :

6f. Rewriting of records :

Business Interruption

6g. Insurable gross profit :

6h. Increased cost of working :

6i. Claims preparation costs :

6j. Accounts/Loss of debtors

Burglary

6k. Stock :

6l. Tobacoo/Cigarettes :

6m. All other contents :

6n. Theft without forcible entry :

Money

6o. In Transit :

6p. Business Hours :

6q. Outside Business hours :

6r. Seasonal cover (Weekends, Public Holidays, Christmas) :

6s. Locked Safe :

6t. Residence :

6u. Safes/Strongrooms :

Glass

6v. External :

6w. Internal :

6x. Illuminated and Neon Signs :

Liability

6y. Public

6z. Products :

General Property

7a. General Property :

Computers

7b. Hardware :

7c. Data Media :

7d. Inc. Costs :

7e. Software :

Machinery

7f. Unspecified :

7g. Specified Items :

7h. Boiler/Pressure Vessels require certification

7i. Food Spoilage

Goods in Transit

7j. Goods in Transit :

Fidelity Insurance

7k. Number of Staff :

7l. Amount of Cover :

8. Contact Details

Please enter your contact details below so we can contact you regarding your quotation

8a. Your Full Name : *

8b. Daytime Phone Number :

8c. Your Email Address : *

8d. Your Facsimile Number :

8e. Your Postal Address :