Call us on: (08) 9272 4611

enquiries@constructionrisk.com.au

Professional Builder | Owner Builder

Office Location: 1st. Floor, 58 Walcott Street, Mt. Lawley

Owner Builder

Construction and Workers Compensation Home Indemnity Insurance

Forms

Insurance Package Form

Application Form

Enquiry Form

Contact Information
Name of Business / Applicant :
Trading Name:
Contact Name: Contact No: Email Address:
When is the best time for Construction Risk Insurance to contact you:
Morning Afternoon

Current Insurance Details

CONSTRUCTION & LIABILITY INSURANCE

Name of your Insurer : Expiry Date of Policy :

WORKERS COMPENSATION INSURANCE

Name of your Insurer : Expiry Date of Policy :

Has any party to this insurance made a claim within the last 5 years against an Insurance Company or any type of Construction/Liability or Workers Compensation Insurance, or have suffered any losses previously uninsured in this period?
Yes No

If 'yes', please provide details below:
Has any party to this insurance ever been declined, deferred or accepted on special terms for either Construction/Liability or Workers Compensation Insurance or is such action pending?
Yes No

If 'yes', please provide details below:
Please indicate what you require Construction Risk Services to provide you a quotation for:
a) Construction/Liability Annual Basis Yes No
b) Construction/Liability Job Specific Basis Yes No
c) Workers Compensation Annual Basis Yes No
d) Workers Compensation Job Specific Basis Yes No

If you require assistance with any of our forms please do not hesitate to contact us on the following:

Telephone: (08) 9272 4611

email: enquiries@constructionrisk.com.au

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