Workers Compensation Insurance Quote

Contact Name
Postcode
Email Address
Phone Number

Preferred Method Of Contact—Please choose an option—EmailPhone
Do You Hold A Current Workers Compensation Insurance policyYesNo
Date Of Incident
Description Of Business Products or Activities
Total Estimated wages payable over the next 12 months (including working directors, family members, and contractors wages)—Please choose an option—$0-$10,000$10,001-$30,000$30,001-$60,000$60,001-$90,000$90,001-$120,000$120,001-$150,000$150,001-$250,000$250,000+
Estimated number of employees—Please choose an option—1-1010-2020-3030+

Is cover required for working directorsYesNoUnknown
Are Contractors or Sub-Contractors usedYesNoUnknown
Are part time or casual workers employedYesNoUnknown
Is there a formal OHS plan in place?YesNoNot Applicable
Have you had any insurance declined or cancelled, proposal rejected, renewal refused, claim rejected, special conditions or special excess imposed by an insurer YesNo
Have you had any Workers Compensation claims in the last 5 yearsYesNoNot Applicable
Would you also like a quote forIncome Protection InsuranceEmployee Journey InsuranceBusiness Package InsuranceManagement Liability InsuranceProfessional Indemnity InsuranceMarine Transit InsuranceLife InsuranceLiability InsuranceMotor InsuranceBusiness Interruption InsuranceMachinery Breakdown InsuranceHome Building, Contents & or Landlords InsuranceNone of these extras, just Workers Compensation Insurance

I confirm the above information is true and correct