COMMERCIAL ISR PROPERTY
distribution@australiaunderwriting.au
© 1300 28 7475 | 1300 AURISK | T: 03 7064 4800
Insured Information
The Insured (Must be registered to a commercial entity for Residential properties)
ABN
Names of the directors) or trustee(s) of the insured entity
Interested Party(s)
Period of Insurance
Period of Cover
Your current, proposed or expiring premium
Type of Premises
Risk Address
Important Information to be declared:-
We rely upon this proposal form and it is important to us that you make specific enquiries with each applicable party described in (i), (i), (i) & (iv) below prior to answering the questions and signing the declaration.
If you feel unable to answer a question(s) accurately or have a material fact or circumstance(s) to disclose please provide full details in the additional information box on page 5.
(i) You and insured family members
(ii) Any Director or Partner
(ili) Any person (s) with a beneficial interest of 25% or more in the business (other than mortgagees)
(iv) Any person with management control of the insured entity (other than professional letting agents that you have contracted to manage the property:
Have any of the parties described in (i) - (iv) above:
1. Been convicted of, or had any fines or penalties imposed for, a criminal offence in the last 10 vears?
Yes
No
2. Been placed in bankruptcy, receivership or liquidation within the last ten years?
Yes
No
3. Had any insurance refused, cancelled or had special conditions or restrictions imposed on your policies?
Yes
No
4. Has another insurer made risk recommendations in respect of your business that have not been attended to?
Yes
No
5. Are there any exceptional circumstances or anything special or unusual about your business which would increase the likelihood of loss, destruction, damage or liability?
Yes
No
6. Made a claim or suffered a loss by any event for which Insurance is now being proposed within the last five years?
Yes
No
If you have answered Yes to any question(s) or feel that you have been unable to answer a question(s) accurately, please provide full details
The Property
8. Are any parts of the premises occupied either by you or any tenants?
Yes
No
If yes, please provide more details?
Approximate age of the building:
(either the age, year of build or decade the building was built)
9. Approximate square meters of the building:
10. Number of storeys of the building:
11. Number of storeys of the building:
12. Number of buildings on the property:
13. Is the property heritage listed?
Yes
No
14. How long have the Premises been unoccupied?
Less than 12 months
Up to 2 Years
3 - 5 Years
5 Years +
15. How long is it anticipated that the Premises will remain unoccupied?
.
What is the future for the building?
Construction: a) Walls
.
.
B) roof
.
.
c) Floor
.
.
.
d) Contains EPS (Coldroom, Expanded Polystyrene or Insulated Sandwich Panels)
If yes, please confirm which of the following represents EPS:
A cool room that is separate to main structure
Yes
No
A cool room that is part of the main structure that is less than 20% of the total building footprint
Yes
No
A cool room that is part of the main structure that is greater than 20% of the total building footprint
Yes
No
EPS (not a cool room) less than 20% of the building
Yes
No
EPS (not a cool room) more than 20% of the building
Yes
No
If yes, please provide more details?
Approximate age of the building:
Approximate square meters of the building:
Number of storeys of the building:
Number of buildings on the property:
Is the property heritage listed?
How long have the Premises been unoccupied?
Less than 12 months
Up to 2 Years
3 - 5 Years
5 Years +
How long is it anticipated that the Premises will remain unoccupied?
SUBMIT