Professional Indemnity Application Form

Welcome. We're making it easy for you to obtain a quote, renew a policy and buy online now.
  • Select the level of cover that suits your business
  • Pay online by credit card or select a monthly payment plan
  • Receive your documents the same day
To obtain your PI quote and buy now simply complete your business details below. You can also save your quote and come back later.

View Policy benefits here

Please call us if you have any questions. We're here to help you.

Insured Details

 Insured Legal entity name(s) & Trading as:  
Add Another Insured Name

Mobile Phone Number:


Email Address:
Re-enter Email Address:

Income Details
   Past 12 months    Next 12 months
Total Professional Fee Income    $     $ 
Please note: As your professional fees are over $1million you will not be provided a quote automatically by the portal, you should proceed through the whole application and the IPA Insure team will review your application and provide you with a quote.

Occupation

Public PractitionerTax AgentBAS Agent/Bookkeeper


Do you hold or have you applied for a FULL Professional Practice Certificate?
 		YesNo
Do you hold or have you applied for a LIMITED Professional Practice Certificate?
 		YesNo


In respect of income earned for the past 12 months, please provide a percentage by State:
NSW ACT QLD VIC TAS SA WA NT Overseas
% % % % % % % % %  Total must be 100% %

Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?   YesNo

Period of Insurance

Policy Start date (dd/mm/yyyy):

Note: This date will be used as the start date for your new policy.

Promotional Code (if relevant):