ADELAIDE | BRISBANE | MELBOURNE | PERTH | SYDNEY
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1. Contact Details
3. Insurance Information
What is your primary profession
Please advise your profession
Select types of insurance
Please advise what type of insurance you are interested in.
How did you hear about us?
Australian Institute of Architects
Planning Institute of Australia
Design Institute of Australia
What was the other way?
4. Business Details
List full name of all current entities and prior incorporated to be insured. It is essential to specify the names of all entities including trading names, service, administrative or nominee companies and subsidiaries that you wish to be covered by this policy.
Please answer the following questions after enquiry within the practice.
Have any claims or allegations of negligence or breach of professional duty been made in the last 10 years against the practice (or any of its predecessors in business or any prior practice of any of their present or former partners, principals or directors), OR have circumstances been notified to insurers that might give rise to a claim?
We may ask you additional information about this.
5. Provide details of each principal/partner/director.
How many principals / partners / directors:
Does the practice currently hold professional indemnity insurance?
Please advise when practice last held professional indemnity insurance.
6. Provide details of the practice’s professional fees.
Professional fees earned for last 12 months (Excluding GST).
Estimated professional fees for the next 12 months (Excluding GST).
7. Provide a breakdown of professional fees earned for the last 12 months (Note: If a new practice, provide an estimate).
Do you engage consultants, sub-contractors or agents?
Do you insist they carry their own professional indemnity insurance?
List professions of subconsultants
8. Express as a percentage, the practice’s professional fees derived from the following activities:
Engineering – Structural
Engineering – HVAC
Engineering – Acoustical
Engineering – Geo Tech / Soil
Drafting / Building Designing
Engineering – Plumbing
Engineering – Environmental
Project / Construction Management
Furniture / Product /Industrial Design
Teaching / Lecturing / Education
TV / Film / Theatre / Set / Exhibition/Display
Multimedia / Digital Media / Visual Communication / Web Design / Graphic Design
Please specify other
9. State the approximate percentage of work undertaken in the following areas:
Commercial / Industrial Buildings
Low Rise Buildings (up to 5 storeys)
High Rise Buildings project value under $75m
Bridges / Tunnels
High Rise Buildings project value above $75m
Pre-Purchase Building Inspections
Commercial Tenancy Fitout
Roads / Drainage
Schools, Hospitals, Municipal Buildings
Trade Shows, Exhibitions
Environmental Appraisails / Impact Assessments / Audits
Hotels / Motels / Pubs
Acoustic & Noise Prevention
Sports Centres / Clubs
Swimming Pools Commercial
Retail Shops, Flats, Townhouses
Swimming Pools Domestic
Modular Buildings (involving repetitive design)
Teaching / Lecturing
Feasibility Studies, Investigation or Reports
Expert Witness / Mediation
Please specify other
Limit of indemnity required:
10. Other Insurances:
Please advise if you are interested in obtaining details regarding the following insurance products to further protect your business.
Office or Business Insurance
Business Travel Insurance
Contract Works Insurance
Fleet Motor Insurance
Life / TPD Insurance
Income Protection Insurance
Supporting documents: include CV / qualifications for startup practices or a Policy Schedule / Certificate for your current policy.
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Any additional comments?
I/We hereby declare that:
I/We have read and understood the important notices available from the following
The persons noted below are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this proposal and that I/we complete this proposal on their behalf.
The above statements are true, that I/we have not suppressed or mis-stated any facts, and that should any of the information given by me/us alter between the date of this proposal and the inception date of the insurance to which this proposal relates I/we will give immediate notice thereof.
• Enquiry should be made of all principals/partners/directors and senior staff to ensure full disclosure.
• Agreeing to the above does not bind the practice to accept the insurance or the insurers to provide a quotation.
I / We confirm the above declaration