cleaning contractors questionnaire

Please complete this form to apply for Cleaning Contractor's Insurance.
YOUR CONTACT DETAILS
Your Name
Business Trading Name
Contact Phone Number
Fax Number
Website Address
Email Address
Postal Address
INSURANCE DETAILS
Who are the Holding Underwriters?
What is the limit of liability?
The period of your insurance?

BUSINESS DETAILS
How long has the insured been trading?

BUSINESS TURNOVER
Please state your annual turnover, split into the following categories:
Domestic Cleaning $ 
Office Cleaning $ 
Retail/Shopping Centre Cleaning (after hours) $ 
Retail/Shopping Centre Cleaning (trading hours) ** $ 
Other Commercial Cleaning $ 

LABOUR INVESTMENT DETAILS
Wage Roll Amount $ 
Are subcontractors used?
If Yes, please list annual dollar value and details
Are labour hire workers used?
If Yes, please list annual dollar value and details

RETAIL SHOPPING CENTRE CLEANING (Trading Hours)
Please complete this if you entered an amount in the turnover section, in the "Retail/Shopping Centre Cleaning (trading hours)" slot.

1. Is there a food court in the shopping centre?
2. How many hours per week of cleaning is involved?
3. How many cleaners are used?
4. Are the floors polished/buffed, if so how, and how often?
5. Is there a loop cleaning requirement? What are the details.
6. Has any liability been assumed under the contract? (Please provide copies of the contract)

Colours used to reference questions above for each shopping centre.
First Shopping Centre Name
Shopping Centre Address
1 Court 2 Hrs 3 Qty 4 Floors Floor Details 5 Loop 6 Liability
Second Shopping Centre Name
Shopping Centre Address
1 Court 2 Hrs 3 Qty 4 Floors Floor Details 5 Loop 6 Liability
Third Shopping Centre Name
Shopping Centre Address
1 Court 2 Hrs 3 Qty 4 Floors Floor Details 5 Loop 6 Liability
Fourth Shopping Centre Name
Shopping Centre Address
1 Court 2 Hrs 3 Qty 4 Floors Floor Details 5 Loop 6 Liability
Fifth Shopping Centre Name
Shopping Centre Address
1 Court 2 Hrs 3 Qty 4 Floors Floor Details 5 Loop 6 Liability
Sixth Shopping Centre Name
Shopping Centre Address
1 Court 2 Hrs 3 Qty 4 Floors Floor Details 5 Loop 6 Liability
Seventh Shopping Centre Name
Shopping Centre Address
1 Court 2 Hrs 3 Qty 4 Floors Floor Details 5 Loop 6 Liability
OTHER DETAILS
Is loss of keys cover required?
If Yes, what limit is required? $ 
What is your claims experience for the last 5 years?



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DECLARATION

By pressing the 'Send Questionnaire' button, we declare that to the best of my/our knowledge and belief the above statements and particulars are true and correct.