Contact Details

Insured Name *

Contact *

Phone *

Email Address *

ABN

Date of Establishment

Address *

Street address *Street address line 2

City *

State *Please selectACTNSWNTQLDSATASVICWA

Postcode *

CountryPlease selectAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

Limits of Indemnity

Limit of indemnity for Professional Indemnity Insurance *$1,000,000$2,000,000$5,000,000$10,000,000Other

Limit of indemnity for Public/Products Liability *$5,000,000$10,000,000$20,000,000Other

Please specify

Please specify

Business Details

Please provide a detailed description of your professional business, which is required to be covered by this policy *

Total Number of Staff *

Total Number of Directors *

Total Number of Qualified Staff *

Gross Revenue Earned

Last financial year's gross fees (AUD $) *

With respect to gross fees for the last financial year, please provide a breakdown by state: *

NSW

ACT

QLD

VIC

TAS

SA

WA

NT

Overseas

General Information

Does the company have operations outside of Australia *

YesNo

Does the company have operations in the USA/Canada?

YesNo

Please provide further details

Have any claims been made against the company for Professional negligence, error or omission in the last 5 years? *

YesNo

Details

Claim Amount

Payments

Income Breakdown

Please provide a breakdown of your gross fees/income by Professional Business for the last financial year by stating the relevant percentage (must be a total of 100%):  *

Architect

Architectural Contract Management

Architectural Drafting

Architectural Heritage

Architectural Interior Design

Architectural Landscaping

Naval Architecture

Architectural Project Management

Building Designer

Other (please specify)

Please indicate the percentage of the firm's income derived from the following job categories (must be a total of 100%): *

Domestic Building (Excluding Flats/Units/Town Houses)

Commercial Buildings (Including Flats/Units/Town Houses)

High Rise Buildings (Exceeding 3 floors and not otherwise specified)

Institutional Buildings (Ecclesiastical/health/educational)

Feasibility Studies (where not involved in design/construction)

Soil Testing/Surveys of Sub – Surface condition

Town Planning

Other (please specify)

 

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