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.

Policy benefits: Your PI policy includes 14 months cover for the price of 12, saving you money.

View more benefits here

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

Insured Details

Legal Name and/or Business Name (Name of Insured):  

Contact Phone Number:


Email Address:

Re-enter Email Address:

Income Details

   Past 12 months    Next 12 months
Total Professional Fee Income    $     $ 

Occupation

Public PractitionerTax AgentBAS Agent/Bookkeeper

Do you hold a 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
and the policy will expire 14 months after this date.


Promotional Code (if relevant):
 


  

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