Insurance provider for Hotels, Motels, Clubs, Nightclubs, Restaurants, Amusement Arcades underwritten by Lloyds of London - High Street Underwriting Agency based in Brisbane



Insurance Quote form - High Street Underwriting - Insurance providers for Hotels, Motels, Clubs, Nightclubs, Restaurants, Amusement Arcades, underwritten by Lloyd’s of London - Brisbane based Australian Commercial Property & Liability insurance Provider. Australia wide
High Street Underwriting Agency - Brisbane Insurance Provider for Australia wide - underwritten by Lloyds of London
High Street Underwriting Agency based in Brisbane - insurance provider for Hotels, Motels, Clubs, Nightclubs, Amusement Arcades underwritten by Lloyds of London

 


Please  submit the on-line form below or DOWNLOAD the form and fax back to 1800 096 680

 
ON-LINE QUOTE QUESTIONNAIRE FORM
 
 

PROPOSER'S DETAILS
FULL BUSINESS NAME:
CONTACT NAME:
EMAIL ADDRESS:
ADDRESS LINE 1:
ADDRESS LINE 2:
TOWN/CITY:

DESCRIBE ALL BUSINESS ACTIVITIES AT PREMISES:

WHAT TYPE OF LICENCES ARE HELD:

 

GENERAL CONSTRUCTION DETAILS
WALLS:
FLOOR:
ROOF:
 

LOCALITY

City or town with reticulated water supply & full time brigade

YES

NO

City or town with reticulated water supply & volunteer brigade

YES

NO

Area with no reticulated water supply but with a fire fighting service

YES

NO

Area with no reticulated water supply or nearby fire service -
please provide fire protection details

YES

NO

 

FIRE PROTECTION

Sprinklered risks (Regularly serviced & reliable water supply)

YES

NO

Monitored Hardwired Smoke/Heat Detectors

YES

NO

Hose reels/Hydrants (Reliable water supply)

YES

NO
 

SECTION 1 - MATERIAL DAMAGE
BUILDING $:
MACHINERY, PLANT AND
ASSOCIATED CONTENT $:
GAMING AMUSEMENT AND ENTERTAINMENT EQUIPMENT $:
LIQUOR AND TOBACCO $:
ALL OTHER STOCK AND
MATERIALS IN TRADE $:
RENT PAYABLE $:
GUESTS & VISITORS PERSONAL EFFECTS (automatic cover of $500) $:

SPECIFY OTHER PROPERTY $:

A:

B:

 

SECTION 2 - BUSINESS INTERRUPTION/SECTION 3 - BOOK DEBTS

CALCULATING YOUR INCOME
1. Detail Estimated Turnover in next 12 months $:
2. Less cost of consumables $:
3. Sub Total $:
4. Add any anticipated increase in the next 12 months $:
Total= $:

NOTE: When a longer indemnity period is required (18, 24 or 36 months) the Loss Limit
should be increased accordingly with due regard to anticipated business trends.
 
LOSS of GROSS REVENUE

LOSS LIMIT/SUM INSURED

INDEMNITY PERIOD IN MONTHS
Loss of Gross Revenue $:
Increased Cost of Working $:
Loss of Rent Receivable $:
Book Debts $:
 

SECTION 4 - MONEY

MONEY AND PERSONAL ACCIDENT (ASSAULT) EXTENSION

Specify Negotiable Money loss limit required whilst:
a) Contained in locked specified safe (s) $:
b) Not in specified safe(s) $:
c) In transit $:
On premises during business hours $:

NOTE: Cash over $15,000 to be combined in an approved Safe. In respect of cash carrying limits - one able-bodied person $15,000, 2 able-bodied persons $15,001 to $25,000,
3 able-bodied persons $$25,001 to $50,000, Refer over $50,000
 

SECTION 5 - GOODS IN TRANSIT
State Value of estmated annual carry $:

NOTE: Maximum any one vehicle - $5,000
 

SECTION 6 - GLASS
Is Internal & External Glass Cover required
(Neon Signs are included):

YES

NO
State Value of any special glass i.e. glass that is bent, lettered, embossed, etc. $:
 

SECTION 7 - DETERIORATION OF STOCK
Please state the Value of Food contained in refrigeration units $:
 

SECTION 8 - FIDELITY GUARANTEE

FIDELITY GUARANTEE
Number of employees:
Limit $:
 

SECTION 9 - PUBLIC AND PRODUCTS LIABILITIES

PUBLIC & PRODUCTS LIABILITY - LIMIT $10,000,000
Estimated Annual Turnover - Bottleshop $:
Estimated Annual Turnover - Gaming $:
Estimated Annual Turnover - All other income $:
Do you have entertainment?:

YES

NO

DETAILS:

Do you have a Night Club?:

YES

NO
How many days per month:
Opening hours:
Do you retain Security Guards?:

YES

NO
If YES, are Security Guards Contracted?:

YES

NO
 

CLAIMS INFORMATION

CLAIMS DETAILS
Have there been any incidents in the past three years which have or could have given rise to claims under any section for which cover is required?:

YES

NO

If YES, please detail all claims below including any payments made or reserves outstanding:

 


THANK YOU!



 


© High Street Insurance Underwriting P/L PO Box 7174 Brendale QLD 4500

P: 1800 096 829   F: 1800 096 680   EMAIL US   

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Insurance Providers - Underwritten by Lloyd’s of London - High Street Underwriting Retail & Wholesale Insurance -  Brisbane based






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