(08) 6147 3200
ultra@uis.com.au
Home
Obtain a Quote
2
Quote Form Commercial Landlord
Contacts
Situation at Risk
Insurance Options
Insurance History
Additional Information
Contacts
Previous
Next
Name
Email
Phone number/mobile
Date of birth
Business Details
Registered for GST
Yes
No
Business structure
Company
Incorporated Association
Other
Partnership
Personal
Private Company (Pty Ltd)
Publicly Listed Company (Ltd)
Self Managed Superannuation Fund
Sole Trader
Superfund
Trust
Describe business structure
ABN
Company or Insured name
Trading as
Mailing address
Address Line 1:
Address Line 2:
Town/Suburb:
Postcode:
State:
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Situation at Risk
Previous
Next
Is the business address the same as the mailing address?
Yes
No
Business address
(Cannot be a PO Box)
Address Line 1:
Address Line 2:
Town/Suburb:
Postcode:
State:
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Is your property
Across more than one location
A Residential Building
Predominantly Wooden Construction
Heritage Listed
Located north of the tropic of Capricorn (i.e. Rockhampton in the east or Carnarvon in the west) and within 100km of the coastline?
Floor area exceed 20% of EPS construction? Or does the risk have more than 10% asbestos in construction?
Requiring building insurance and if so it needs to be insured as a Strata Title?
Unoccupied
Is flood cover required?
None of the Above
Is the insured(s) primary business activity that of a commercial property owner?
Yes
No
Is this a multi-tenant?
Yes
No
Tenant occupation (single tenant) or Property Owner ANZSIC (multi-tenant)
Please enter the tenant’s business description – if multi-tenant list all tenant occupations
Year of Construction
Building type
Please select
Freestanding House
Townhouse
Terrace
Apartment / Flat / Unit
Semidetached
Duplex
Triplex
Quadruplex
Granny Flat
Nursing Home Unit
Retirement Village Unit
Other
Construction of Walls
Please select
Brick
Concrete
Steel Frame - Iron/Steel
Wood Frame - Iron/Steel
Asbestos
Fibro
Other
Wall construction
Construction of Roof
Please select
Iron/Steel
Concrete
Tiles
Fibro
Wood
Asbestos
Other
Roof construction
Construction of Floors
Please select
Concrete
Concrete and Wood
Wood
Other
Floor construction
Fire Protection
Fire Extinguishers
Fire Blanket
Hose Reel
Local Fire Alarm
Monitored Fire Alarm
Internal Fire Sprinklers
External Fire Sprinklers
Is this situation serviced by Town Water supply and Full Time Fire Brigade?
Yes
No
Insurance Options
Previous
Next
Property
Building sum insured
$
Specified contents
Description
Sum insured
$
+/-
Business Interruption
Indemnity period
Please select
12 months
18 months
24 months
Insurable gross profit
$
Additional increased cost of working
$
Loss of rent
$
Other Income
$
Theft
Works of Art, Antiques & Curios
$
Rewriting of Records
$
Home Office Contents
$
Specified valuables
Description
Sum insured
$
+/-
Money
On premises - Business hours
$
On premises - Outside business hours
$
In a private residence
$
Rent Default
Is rent default cover required?
Yes
No
Glass
Is the property owner responsible for glass?
Yes
No
Tax Audit
Tax audit sum insured
$
Legal Costs for Occupational Health and Safety Breaches
Legal costs and expenses incurred under occupational health and safety breaches
$
Legal Liability
Is cover required for Third Party Liability?
Yes
No
Limit of Indemnity for Legal Liability
$
Turnover
$
Damage or loss of goods in your possession or legal control
$
Machinery Breakdown
Is machinery breakdown cover required?
Yes
No
Insurance History
Previous
Next
In the last 5 years have you
i. had insurance refused, cancelled, declined, or special terms imposed?
Yes
No
ii. been declared bankrupt, placed in liquidation, receivership, or voluntary administration?
Yes
No
iii. been convicted of or had any fines imposed for any crime involving drugs, dishonestly, arson, theft, fraud, or violence against any person or property, including association with Outlaw Motorcycle Gangs or Organised Crime Gangs?
Yes
No
If yes to any of the above questions, please provide details. Alternatively, call us on (08) 6147 3200.
Claims History
In the last five years has the owner or business suffered any loss or claims made against you that has not already been declared?
Yes
No
List any claims from the last 5 years
Insurer
Claim date
Type of claim
Amount paid
Finalized
Description
Please select
Malicious Damage
Water Discharge/Burst Pipe
Glass External/Internal
Impact/Vehicle
Theft/Burglary
Liability – Property
Liability – Personal Injury
Electrical/Fusion/Pumps
Other
Storm Damage – Building/Contents
Fire
Accidental Damage
Storm Other
Malicious Damage
Hail Damage
Storm Damage - Fence
$
Please select
Finalized
Not Finalized
Additional Information
Previous
Submit
Please provide any additional information relevant to your risk, or additional covers you may require
Policy effective date
Policy expiry date
Would you like to pay monthly?
Yes
No
Who is your current insurer?
What is your current premium?
$
What is your current excess?
$
Promo code