Newsagent Insurance Quote 

Insured Details
Details of the Business and Premises
Yes  No
Details of Security
Building and Contents
Business Interruption
Burglary (Sums Insured) Cover
Money (Sums Insured)
Glass cover
Yes  No
General Liability Products Liability
Lotto Indemnity $1,000,000 (Included Free)
Optional Covers
Insurance and Claims History
Have you (in the past 5 years)
Yes  No
Yes  No
Yes  No
Have you or any partner(s)
Yes  No
Yes  No
Yes  No
Yes  No
Yes  No
Declaration
I declare and acknowledge:
  • that I am, after enquiry, authorised by all person(s) or entities seeking insurance, to make this proposal;
  • that after enquiry, all information supplied in this proposal and any supporting documents attached to this proposal or supplied separately, is true and correct and I have not withheld any material information from this proposal;
  • that this proposal and any accompanying documents shall form or partly form the basis of the contract proposed;
  • that until a Contract of Insurance is entered into, I am obliged to inform the Underwriters of any changes to any information supplied or of any new information that is relevant;
  • that I understand the Underwriters relies on the accuracy of the information and documentation supplied proposing for this insurance;
  • that I understand that no insurance is in force until a Contract of Insurance is entered into, which is upon the Proposer’s acceptance of an offer by the Underwriters, if any.
Yes  No
* Indicates a mandatory field.

 
© Copyright 2021 Fitzpatrick and Co. Insurance Brokers Pty Ltd
ABN: 25 050 242 914 | AFS Licence 244386 |