Request a PI Quotation

Please complete the details below, and we can arrange to provide you with an indication of the potential professional indemnity premiums within two working days.

Alternatively, if your enquiry is urgent, you can contact the office directly on 1800 993 519 and ask for either Damian Harrison, Paul Elphick or Roshan D'Souza, or email [email protected]

PROFESSIONAL INDEMNITY INDICATION REQUEST FORM

* Indicates required field

Name of Practice *

Postal Address *

State *

Postcode *

Contact Name *

First

Last

Telephone Number *

Email Address *

Renewal Date *

Limit of Indemnity *

Current Excess *

Current Insurer *

Annual Premium at Last Renewal *

Number of Staff including Directors / Principals *

Income for the Last Completed Financial Year *

Estimated Income for the next 12 Months *

List all Activities and percentages (e.g. Architecture, Engineering, Interior Design, Town Planning, Project Management etc) *

Largest project in the past 5 years (in terms of the overall construction costs) *

Please provide details of any Claims and/or Notifications in the past 10 years *

Please enter any other additional information which you feel may be relevant, such as qualifications, experience, professional membership, quality assurance etc. *

If you are able to attach a copy of your last completed proposal form, we will arrange for an exact quotation to be provided instead of just an indication *

Max file size: 20MB

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﻿﻿PROFESSIONAL INDEMNITY INDICATION REQUEST FORM

PROFESSIONAL INDEMNITY INDICATION REQUEST FORM