ISR Proposal From Download PDF Form InsuredInsured Name(Required)ABN(Required)Business Description(Required)ContactWebsite How many situations require cover under this policy(Required)BrokerBrokerageIntermediary NumberAccount Manager NameBroker Phone NumberAccount Manager Email Broker Mobile NumberSchedule of Questions / General InformationIn the last 5 years, Have You or any Director, Manager or Partner of the businessHad insurance declined or cancelled?(Required) Yes No Please provide more informationHad any special conditions or excess imposed on your insurance?(Required) Yes No Please provide more informationHad any claim declined?(Required) Yes No Please provide more informationBeen declared bankrupt or had any business placed in adminstration?(Required) Yes No Please provide more informationBeen charged and convicted with any criminal offence?(Required) Yes No Please provide more informationHas the insured incurred a claim in the past 5 years?(Required) Yes No if yes; new line per claim. Add RemoveHas the insured suffered a loss >$100,000 ever?(Required) Yes No if yes; DetailsSituation DetailsSituation #(Required)Street NumberStreet NameSuburb(Required)State(Required)Postcode(Required)Primary occupancy at this address(Required)Secondary occupancy at this address.Construction# of storeysWallsInternal frameRoof CoveringRoof FrameFloors (list all)Age of BuildingLast renovation (cost and details)If more than 1 storey, list the details belowFloor LevelAge of BuildingLast renovation (cost and details) Add RemoveSandwich pannelling? Yes No Type of panel?Amount of panel by floor space %?Is there asbestos on site? WhereHeritage Listed? Yes No Electrical InfrastructureAge of Main SwitchboardWhen was the last inspection?Are all appliances subject to test and tag as per australian standard? Yes No Are contractors engaged for annual inspections/testing. Yes No Is there any cooking on site? Yes No Are contractors engaged to clean exhaust ducting, flues and filters? Yes No Frequency?Is there forklifts in use on site? Yes No Battery or LPGBatteryLPGDedicated charging station clear of combustible construction or commodityAre spare gas cylinders stored within locked cabinets, clear of hazard?Is there charging of any Lithium ION batteries/portable equipment on site? Yes No Dedicated charging station clear of combustible construction or commodityFlammable / Hazardous Materials Storage & Handling Yes No Stored correctly according to Australian Standard? Yes No Fire Detection & ProtectionSprinkler System? Yes No Supply (Dual or Single)Sprinkler %Smoke detection? Yes No Coverage %Hardwired or battery?Monitored by a third party? Yes No Local Only? Yes No Theft & SecurityDo you have any of these on site? CCTV Security Patrols Burlgary alarm (Local or monitored) Window Security Grills Burglar Alarms Do you hold over 10,000 in cash on premises? What sort of safe is used?Do you use contracted money carriers?Situtation Declared ValuesBuildingContentsStockRemoval of DebrisSublimitsSection 1Burglary (other than money)Extra Cost of ReinstatementGlassMoneyUnspecified/accidental damagePropety in Open AirOther Add RemoveSection 2Gross ProfitRental IncomeACIOWPayroll100% x weeks% x weeksOther Add RemoveAggregated Schedule - Total Insured Value (TIV)Section 1 - Material Loss or DamageBuildingsContentsStockRemoval of DebrisAdditional Extra Cost of ReinstatementSection 2 - Consequential LossGross ProfitRental IncomePayrollClaims Prep. CostAdditional Extra Cost of ReinstatementIndemnity PeriodCombined Section 1 & 2 - Material Loss or DamageDeclarationI declare that to the best of my/our knowledge and belief the answers given above, documents or papers submitted, represent the true position and that We have not withheld any information, material to this proposal. I acknowledge that no cover is provided unless and until; Ocean Underwriting advise in writing of the cover and terms which they can provide, and this cover including the terms and conditions is then accepted by me, and Ocean Underwriting are advised by me of acceptance of their cover and terms offered, and Ocean Underwriting acknowledges to me that cover is provided. Where answers in this proposal are not in my own handwriting, they have been checked by me and I agree that they are correct. I have read and understood the Your Duty of Disclosure notice in this proposal form. I authorise Ocean Underwriting to give to, or obtain from other insurers or an insurance or credit reference bureau, any information relating to or which may impact on this insurance cover, and any other insurances held by Me and claims under those insurances. I agree that this proposal and accompanying documents or papers shall form part of this proposal and are the basis of the insurance contract proposed. Untitled(Required) I have read and agree to the duty of disclosure requirements. Declaration signature(s) on behalf of the applicants:Signature(Required)Print Name:(Required) First Last Phone Number(Required)Date(Required) DD slash MM slash YYYY Your email address (to receive a copy of this proposal)(Required) Δ