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BCIB Insurance Brokers are Australia’s leading Insurance Broker to the Club Industry

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Club Insurance Request

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Club Insurance Request

Our business pack question set covers the following sections, click NEXT and complete the form with as many details as possible.
- Fire & other specified perils
- Business Interruption
- Burglary
- Money
- Glass
- Liability
- Transit
- Electronic Computer Breakdown
- Machinery Breakdown
- General Property
- Tax Audit
- Employee Fraud
- Motor Vehicles

Who This Enquiry Is For
For us to provide the best response to your inquiry please complete the following
- This inquiry is for an existing business with current insurance
- This inquiry is for an existing business without insurance
- This inquiry is for a new business
Contact Details
First Name
Surname
Address
Suburb / City
Postcode
Telephone
Mobile
Fax
Email
Business Details
Name of the business
Describe your business
What is the required start date of the insurance?
DD slash MM slash YYYY
Is your business premise address different to your contact address?
- No
- Yes
Business street address
Business suburb / city
Business postcode
Does your business operate from multiple sites?
- No
- Yes
Age of building in years
What is the roof made of?
- Tile
- Steel
What are the walls made of?
- Brickwork
- Concrete
- Steel on steel
- Steel on wood
What are the floors made of?
- Timber
- Concrete
What type of alarm system is installed?
- Monitored
- Local
- None
Fire & other specified perils
Sum Insured
Building $
Stock $
Contents $
Others (please specify)
Description $
Business Interruption
Indemnity Period
- 6 months
- 12 months
Sum Insured
Gross Profit $
Increased Working Cost $
Wages $
Rent $
Other $
Other Description
Total $
Burglary
Sum Insured
Contents $
Stock $
Tobacco $
Combined contents / stock $
Other $
Other Description
Money
Sum Insured
In Transit $
On Premises $
On premises outside $
Business hours $
In Safe $
Personal custody $
Other $
Other Description
Glass
Sum Insured
Internal or External
- Internal - Replacement Value
- External - Replacement Value
Signs $
Liability
Sum Insured
Payout
- $5 Million
- $10 Million
- $20 Million
Turnover $
Wages Paid $
Staff Numbers $
Are you the property owner?
- No
- Yes
Describe tenant's business
Do you import products?
- No
- Yes
Product 1
Country of origin 1
Product 2
Country of origin 2
Country of origin 3
Product 3
Transit
Own Vehicles
Maximum Value per load $
Annualised Total Carry $
Number of Vehicles #
Professional Carriers
Maximum Value per load $
Annualised Total Carry $
Electronic Computer Breakdown
Describe equipment you wish to insure
Sum Insured $
Machinery Breakdown
Sum Insured
Refrigerator
Amount of units
Units $
Air Conditioner
Amount of units
Units $
Other
Amount of units
Units $
General Property
Describe equipment you wish to insure 'away from your business' (e.g. laptop computers)
Sum Insured
Tax Audit
Sum Insured $
Employee Fraud
Sum Insured $
Motor Vehicles
Make and model
Year
Registration Number
Main Driver
Date Of Birth
DD slash MM slash YYYY
The vehicle is garaged
- No
- Yes
Garage postcode
NCB rating or rating number
Use
- Business
- Private
Under Finance
- No
- Yes
Final Questions
Prior to the Insurer accepting any risk they will require information about any claims over the past 5 years where the claims relate to the type of insurances you wish to take out. Please describe those claims:
Email a copy to me
- Tick for yes
Name
This field is for validation purposes and should be left unchanged.

Δ

Domina Group Pty Ltd

+61 2 4255 2855
+61 2 4255 2866
info@domina.com.au

NSW - PO Box 500,
Warilla, NSW 2528

QLD - PO Box 392,
West Burleigh, QLD 4219

Suite 8, 14 George St.,
Warilla, NSW 2528

Find us on:

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BCIB Insurance Brokers

+61 2 4255 2855
+61 2 4255 2866
info@bcib.com.au

NSW - PO Box 500,
Warilla, NSW 2528

QLD - PO Box 392,
West Burleigh, QLD 4219

Suite 8, 14 George St.
Warilla, NSW 2528

Find us on:

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