RAILWAY INSURANCE QUOTE

For a Rail Liability Insurance indication quote, subject to a satisfactory completed and signed proposal, please complete the below:



Insured / Business Name *
Address of business *
Broker Name *
Contact person *
Email address *
Website*
Number of years experience: *  Yrs
Full business description of all activities
(when completing this section please 'paint' a full picture of the risk) *

Details of Operations
Does your company undertake work involving any of the following?
Manufacturing? Yes      No
In Tunnels Yes      No
Demolition Yes      No
Quarrying Yes      No
On offshore oil and gas installations Yes      No
Handling or removal of asbestos in any form whatsoever? Yes      No
Use of explosives other than rail detonators Yes      No
Use of machinery that goes on track? Yes      No
Outside Australia? Yes      No

Estimated Annual Turnover, split as follows:
(a) Rail Activities

(i) Turnover relating to work on over under or adjacent to the track alignment
including platforms *: $
Turnover relating to signaling *: $
Turnover relating to trackside training *: $
Turnover relating to classroom training *: $
(v) Turnover relating to work on embankments or other rail work not falling into (i), (ii), (iii) or (iv) above *: $
(b) Non Rail Activities (please provide details) * $
Total Annual Turnover including Rail activities and non-Rail Activities *: $
Have you had any claims or incidents that may result in a claim?         Yes      No

Do you manufacture, supply, distribute or sell products?

Yes      No
If yes, please provide full details of products and estimated turnover from product sales for the next 12 months.

Limit required:

$10,000,000       $20,000,000
 

With the above information we can provide you with an indication quote subject to satisfactory completed proposal.