Insurer’s Details
Industries / Occupations - Split into dollars or percent
Sub Contractors
Turnover
Turnover (estimated for next 12 months)
No. of Employees:
Contractual Liability
Claims History
Declaration
Your Duty of Disclosure.
You have a duty under the Insurance Contracts Act 1984 before you enter into a contract of general insurance with Connect Liability Solutions to disclose to Connect Liability Solutions every matter that you know, or could reasonably be expected to know, is relevant to Connect Liability Solutions decision whether to accept the risk of the insurance and if so, on what terms.
If you fail to answer all questions fully and accurately, Connect Liability Solutions may find cause to reduce or cancel the cover. This disclosure includes any renewal, extension, variation or the reinstatement of a contract of general insurance.
While completing this proposal, you will have provided us with some private information. We are committed to protecting your privacy in accordance with the Privacy Act 1988 (Cth). We will only use this information for the purpose of the consideration of application for this Insurance or if required to do so by law. You are entitled to access your personal information and request any amendment, update or correction as deemed necessary.
I declare that to the best of my knowledge and belief that the answers given above are the truth and that I have not withheld any information that is considered to be material to this proposed Insurance. I declare that any answers not given in my hand writing have been checked by me for their truth and accuracy
