Quote Request

Complete the form below to request an Accomsure Quotation.

Duty of Disclosure

Under the Insurance Contracts Act, you have to disclose every matter that you know, or could reasonably be expected to know, is relevant to the Insurers decision whether to accept the risk of insurance and on what terms. The duty of disclosure applies on each and every occasion you seek new insurance cover or renewal, alter or extend existing cover.

Your duty does not require discloser on any matter

  • that diminishes the risk to be undertaken
  • that is common knowledge
  • that the Insurance Company knows or in the ordinary course of its business ought to know
  • as to which the Insurer waives compliance with your duty

It is essential that you comply with your duty of disclosure as the Insurance Company may be entitled to deny a claim, reduce it’s liability under the contract of insurance or cancel the contract from its beginning.

 

Please answer the following questions (check Yes or No)

Has any Insurer with respect to any insurance policy held by you or any other person included as an Insured:

a) refused to renew, cancelled, or terminated a policy of insurance?  YES NO
b) imposed special or restrictive conditions, increased excess or premium?  YES NO

Have You or any other person included as an Insured:

c) made any claims in the last 5 years on any insurance policy?asd  YES NO
d) had a claim refused or rejected by an Insurer on any insurance policy?  YES NO
e) been convicted of a criminal offence?  YES NO
f) been placed into administration, receivership, liquidation, bankruptcy?  YES NO
g)

has any person who will who will drive your vehicle(s) had any convictions for driving under the influence of alcohol or drugs, or had a licence cancelled or suspended in the last 5 years?

 YES NO
h) have anything else to declare under your duty of disclosure?  YES NO

Your Details

Insured Name:
Trading Name:
Period of Insurance: From:
To:
Email:
Telephone:
ABN:
Current Insurer:
Current Broker:

Your Business

Please select:  Hotel - Boutique Motel Serviced Apartments Holiday Cabins Bed & Breakfast Guesthouse

Please contact our office for information about Backpackers, Caravan Park, Hotel / Pub / Tavern, Resort, Health Retreat, B&B Self Catering or Farm Stay.

Activities

Is the Business a AAA Tourism member    YES NO
If yes, what is the membership number  

How many accommodation rooms?

 
Does your manager have > 2 years experience in this business    YES NO
Does the owner/manager/staff live on site 24 hours a day    YES NO
Annual Turnover $
Non-Accommodation Turnover $
Is there a licence to sell alcohol    YES NO
Is there a restaurant other than for breakfasts only    YES NO
Restaurant Seating capacity  
Is there a function or conference centre    YES NO

Is there a swimming pool or outdoor spa?

   YES NO

 If yes is it fenced to Australian Standards with signs posted specifying usage, accepted behaviour and life saving procedures

   YES NO

Do all other public/guest faclilities conform with all local, regulatory and/or Australian Standards?

   YES NO

Premises

Year of Construction
How many floors does the building have?
Is the premises on town water  YES NO

Construction

Walls  Brick or Concrete Iron Timber or Fibro Other Other:
Floors  Concrete Timber Other Other:
Roof  Metal Tile Concrete Other Other:

Fire Protection

Hose Reels/Hydrants  YES NO

Smoke detectors hardwired and monitored

 YES NO
Fully Sprinklered to Australian Standards & Serviced  YES NO

Security

Excluding guest rooms – external doors fitted with double keyed Deadlocks  YES NO

Insurance Cover

Property Excess:    $500 $1000
  Building $
  Contents including stock $
  Removal of Debris $
Business Excess:   Same as property
  Gross Income $
  Additional Increased Cost of Working $
  Claims Preparation Costs $
  Indemnity period    6 Months 12 Months 18 Months 24 Months
Theft Excess:   Same as property
  Contents and Stock excluding Tobacco Products $
Money Excess:    $500 $1000 $2000
  Blanket cover subject to Limits for 3) & 5) below $
 

Covering Money Under items 1-5 below with Money on Business Premises during Business hours and in Private Residence limited to a maximum of $ 7,500 or the sum insured whichever is the lesser

  1. Money in Transit
  2. Money on Business Premises
  3. Money on Business Premises outside Business hours
  4. Money on Business Premises in a locked Safe or Strongroom
  5. Money in a Private Residence
  Limit any one item    $10 000 $20 000
Machinery Breakdown Excess:    $500 $1000 $2000
  Limit any one item    $10 000 $20 000
  If cover is required for an item in Excess of $ 20,000 please provide details  
Stock Deterioration of Stock $
Electronic Equipment Excess:   Same as property
  Limit any one Loss $
  Electronic Data and Electronic Data Media $
  Increased Cost of Working $
Broadform Liability Excess:   Same as property
  Limit of Liability    $10 000 000 $20 000 000
Glass Excess:   Same as property
  Replacement Value    YES NO
General Property Items Excess:   Same as property
  Description  
  Description  
  Description  
Employee Dishonesty Excess:   Same as property
  Sum Insured    $10 000 $20 000 Not Required
Tax Audit Excess:   Same as property
  Sum Insured    $10 000 $20 000 Not Required
Transit Excess:   Same as property
  Sum Insured    $10 000 $20 000 Not Required
Employment Practices Excess:    $2 500 $5 000
  Sum Insured    $100 000 $250 000 Not Required
Statutory Practices Excess:    Nil $2 500
  Sum Insured    $250 000 Not required

Commercial Cooking Condition

If there are commercial cooking facilities at the premises can you confirm that:

  1. That the exhaust / extraction system ducting is professionally cleaned annually
  2. That the exhaust / extraction system filters are cleaned weekly
  3. That a minimum of 2 x 4.5kg dry chemical extinguishers are located within the kitchen at a suitable location which generally complies with the following requirements:
    • the extinguishers shall be in a conspicuous and readily accessible position
    • where practicable, the extinguishers shall be located along normal paths of travel and near exits they shall not be located in areas where they will be exposed to temperatures outside of the range 50C to -50C
  4. That a fire blanket is located in the kitchen.
  5. Charcoals are removed from the premises and extinguished, or a stainless steel lid placed over the top of the charcoal bed during non trading hours.
I confirm that I am compliant with the above:  YES NO


Steadfast - Strength when you need it / Westcourt General Authorised Representative / Westcourt General Authorised Representative. Accomsure is a registered trademark of HHIA Pty Ltd T/as Accomsure ABN 49 138 740 468