Liability Renewal Declaration

    1

    Liability Renewal Declaration

    2

    People and Financials

    3

    Operations and Risk

    4

    Products Liability

    5

    Declaration and Submit

    Liability Renewal Declaration

    Split of Activities

    % of turnover
    % of turnover
    % of turnover
    Ensure total equals 100 percent.

    Turnover Percent Split by State

    Ensure total equals 100 percent.

    List of Locations business is conducted from

    Add one per line: Location and occupancy, Owned or Leased, Vacant or Occupied.

    Headcount and Financials

    Contractors and Subcontractors

    Labour Hire and Volunteers

    Contracts and Work Types

    Products you manufacture, assemble, modify or repackage

    Add one per line: Product, intended use, estimated annual turnover.

    Products you import

    Add one per line: Product, country of origin, estimated annual turnover.

    Products you export

    Add one per line: Product, destination country, estimated annual turnover.

    Records, Standards and Recall

    Important Notices

    Please ensure to complete this declaration in full. If additional space is required for any response, provide details on a separate sheet. If any section does not apply, mark as N/A.

    Your duty of disclosure: before you enter into, renew, extend, vary or reinstate an insurance contract, you must tell us anything you know or could reasonably be expected to know that may affect our decision to insure you and on what terms.

    If you do not tell us something you are required to, we may cancel your contract or reduce the amount we will pay you if you make a claim, or both. If your failure to tell us is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed.

    Privacy: any personal information collected will be handled in accordance with the insurer’s Privacy Statement.

    Declaration

    [acceptance* decl-consent] I agree