Information Technology Insurance Professional Indemnity and Public & Products Liability Step 1 of 7 - Policy Pre Registration - Step 1 14% Policy IDAccess CodeHiddenStripe Description HiddenPolicy Status HiddenPolicy Created ByBrokerUserHiddenBroker Code HiddenBroker Name HiddenBroker Website HiddenBroker Logo HiddenBroker Company HiddenBroker Email HiddenCerberos FSG Use Cerberos FSG HiddenFSG Location HiddenAR Broker Yes No Thank you for choosing to apply online. Please complete the details below to get started. The process is quick and easy and will only take a few minutes.When do you want this insurance to start?* DD slash MM slash YYYY HiddenDate - Text HiddenFinish Date DD slash MM slash YYYY HiddenFinish Date plus one year DD slash MM slash YYYY HiddenBinder Doc1 HiddenBinder Doc2 HiddenUMR Policy Finish Date - HiddenHave you been referred by a broker? If so, please enter the broker code How did you hear about us?*ReferralWeb SearchAdvertOtherCAPTCHAThis site uses cookies to track your progress through the application process. As part of EU law we must get your permission to store cookies on your computer. View our Cookies Policy (opens in new tab)Consent* I consent to storing cookies General Advice Warning This information may be regarded as general advice. That is, your personal objectives, needs or financial situations were not taken into account when preparing this information. Accordingly, you should consider the appropriateness of any general advice we have given you, having regard to your own objectives, financial situation and needs before acting on it. Where the information relates to a particular financial product, you should obtain and consider the relevant product disclosure statement before making any decision to purchase that financial product. Policy Wording 1 Policy Wording 2 Financial Services Guide Your Policy Start Date - HiddenRetroactive Date Day Month Year Number of staff including principals and employees*Please enter a number from 1 to 100.Please select the product or services provided or supplied:Product or Services* Application Service Provider Hardware Reselling Software Sales (own developed) or Hardware Sales (own developed) ISP/Web/Internet Services/Hosting Telecommunications Services Website Design/Development ERP Application Services Facilities Management Service (Hosting) Systems Integration LAN and WAN providers Network Design/Development/Support Systems Analysis IT Support and Help Desk Maintenance and Repair Data Processing/Warehousing Services or Data Communication Services IT Education and Training Facilities Management and Outsourcing IT General Consultancy or IT Contracting E-Commerce Application Development IT Project Management IT Security Systems/Consulting Software Maintenance Services You have answered yes to "Other". Please supply details below* Please provide your actual total revenue or turnover for the previous financial year:Last Financial Years Total Revenue$0 to $100,000$100,001 to $200,000$200,001 to $250,000$250,001 to $300,000$300,001 to $400,000$400,001 to $500,000$500,001 to $600,000$600,001 to $700,000$700,001 to $800,000$800,001 to $900,000$900,001 to $1,000,000$1,000,001 to $1,100,000$1,100,001 to $1,200,000$1,200,001 to $1,300,000$1,300,001 to $1,400,000$1,400,001 to $1,500,000$1,500,001 to $1,600,000$1,600,001 to $1,700,000$1,700,001 to $1,800,000$1,800,001 to $1,900,000$1,900,001 to $2,000,000$2,000,001 to $3,000,000Current Financial Years Estimated Total Revenue$0 to $100,000$100,001 to $200,000$200,001 to $250,000$250,001 to $300,000$300,001 to $400,000$400,001 to $500,000$500,001 to $600,000$600,001 to $700,000$700,001 to $800,000$800,001 to $900,000$900,001 to $1,000,000$1,000,001 to $1,100,000$1,100,001 to $1,200,000$1,200,001 to $1,300,000$1,300,001 to $1,400,000$1,400,001 to $1,500,000$1,500,001 to $1,600,000$1,600,001 to $1,700,000$1,700,001 to $1,800,000$1,800,001 to $1,900,000$1,900,001 to $2,000,000$2,000,001 to $3,000,000Last Financial Years Total Revenue Earned Overseas*Current Financial Years Total Revenue Earned Overseas*HiddenNSW Stamp Duty LimitFor the purpose of calculating Stamp Duty please confirm the percentage of revenue earned in each state (must add up to 100%):ACT*NSW*NT*QLD*SA*TAS*VIC*WA*Overseas*HiddenTotal percentage States*Total States should equal 100%Are you a small business eligible for exemption from paying NSW stamp duty on certain types of insurance?* Yes No The NSW Government has created a new small business stamp duty exemption in the Duties Act 1997 (NSW) (the Act) for eligible insurance acquired on or after 1st January 2018 where the proposed Insured is a Capital Gains Tax small business entity (within the meaning of section 152-10 (1AA) of the Income Tax Assessment Act 1997 of the Commonwealth) and a small business individual / partnership / company and/or trust, which is carrying on a business that has an aggregated turnover of less than $2 million.. If you are uncertain whether you are classified as a small business we recommend you seek professional advice and speak to your accountant or financial adviser.HiddenLast financial Years Estimated Gross Revenue*HiddenReview will be required*Due to some of your answers, your quote will be sent for review Your Policy Start Date - Your Indicative Quote:We cannot provide pricing at this time as some of the questions you have answered require a review.Please select the limit of indemnity required:Professional Indemnity Limit Required*$1,000,000$2,000,000$5,000,000$10,000,000Public & Products Liability Limit Required*$5,000,000$10,000,000$20,000,000Compulsory minimum $5M automatically included in this ratingDo you currently have a valid professional indemnity policy?* Yes No HiddenUnlimited / Inception HiddenIs Renewal? No Yes HiddenProfessional Indemnity Limit AggregateHiddenBase PremiumHiddenBase Premium DiscountHiddenBase Premium (Manual)HiddenBase Premium DiscountedAbove MinimumBelow MinimumHiddenBase Premium FinalHiddenBase PIHiddenBase PLHiddenStamp Limit lookupHiddenNSW Stamp TotalHiddenQLD Stamp TotalHiddenVIC Stamp TotalHiddenSA Stamp TotalHiddenWA Stamp TotalHiddenNT Stamp TotalHiddenTAS Stamp TotalHiddenOVS StampHiddenTotal StampHiddenAdmin Fee*HiddenBroker Fee*HiddenBase Premium GSTHiddenBroker Fee with GSTHiddenAdmin Fee with GSTHiddenTotal GSTHiddenPI AggHiddenPolicy Total Amount Your Policy Start Date - About Your Work Please answer the following questions:Has the business been established for more than 2 years and do you have more than 3 years IT & T experience.* Yes No You have answered No to Has the business been established for more than 2 years and do you have more than 3 years IT & T experience. Please let us know what qualifications and/or experience you have in this field.* Is all your work carried out within Australia and subject to Australian Law?* Yes No You have answered no to not having all your work done in Australia. Please provide details below.* Do you undertake any work offshore or do you have offices outside Australia?* Yes No You have answered yes to undertaking work outside of Australia. Please provide details below.* Does the proposer provide any of the following products and/or services:Adult services (including but not limited to producing, hosting and distributing) and/or online gaming and/or gambling and/or lotteries and/or similar applications* Yes No You have answered yes to Adult services (including but not limited to producing, hosting and distributing) and/or online gaming and/or gambling and/or lotteries and/or similar applications. Please provide more details below.* Banking Software and/or online auction sites and/or payment processing and/or financial transaction systems* Yes No You have answered yes to Banking Software and/or online auction sites and/or payment processing and/or financial transaction systems. Please provide more details below.* Social media and/or peer-to-peer platform (including but not limited to filesharing, online marketplaces, property sharing and/or ridesharing) and/or search engines* Yes No You have answered yes to Social media and/or peer-to-peer platform (including but not limited to filesharing, online marketplaces, property sharing and/or ridesharing) and/or search engines, please supply details below.* Mission critical and/or live trading software; blockchain and/or cryptocurrencies and/or payment processing* Yes No You have answered yes to Mission critical and/or live trading software; blockchain and/or cryptocurrencies and/or payment processing, please supply details below.* Medical technology (including but not limited to health/medical diagnostic hardware and/or software and/or health/medical information and/or data services)* Yes No You have answered yes to Medical technology (including but not limited to health/medical diagnostic hardware and/or software and/or health/medical information and/or data services). Please supply details below.* Defence, military, weapons, and/or drones* Yes No You have answered yes to Defence, military, weapons, and/or drones. Please supply details below.* Production line, industrial automation, SCADA/PLC, artificial intelligence and/or manufacturing systems and/or enterprise resource planning software* Yes No You have answered yes to Production line, industrial automation, SCADA/PLC, artificial intelligence and/or manufacturing systems and/or enterprise resource planning software. Please supply details below.* Internet Service Provider and/or data hosting and/or data centre and/or managed services* Yes No You have answered yes to Internet Service Provider and/or data hosting and/or data centre and/or managed services. Please provide details below.* Oil, gas, electricity, water, rail, marine, automotive, and/or aerospace* Yes No You have answered yes to Oil, gas, electricity, water, rail, marine, automotive, and/or aerospace. Please supply details below.* Benchmarking and/or modelling software and/or Encrypting or decrypting software products* Yes No You have answered yes to Benchmarking and/or modelling software and/or Encrypting or decrypting software products. Please supply details below.* Blue-collar work (including but not limited to welding, digging or hot work)* Yes No You have answered yes to Blue Collar Work. Please provide details below.* Underground and/or aboveground mining* Yes No You have answered yes to Underground and/or aboveground mining. Please supply details below.* Fire, security, correctional facility and/or other emergency services* Yes No You have answered yes to Fire, security, correctional facility and/or other emergency services. Please provide details below.* Security systems (including but not limited to Cyber Security and/or CCTV)* Yes No You have answered yes to Security systems. Please provide details below.* HiddenReferral required 1*Due to some of your answers, your quote will require a review Your Policy Start Date - Past ClaimsAre you aware of any shortcoming in your work for a client which is likely to lead to a claim against you?* Yes No Has any claim been brought against you arising from the performance of your business activities or has anyone threatened to bring such a claim?* Yes No You have answered yes to being aware of a shortcoming in your work for a client. Please provide more details below* You have answered yes to a claim being brought against you from your performance of business activities. Please provide more details below.* Has any proposal in respect of the risks to which this form relates ever been declined or has any such insurance ever been cancelled or renewal refused?* Yes No Has there been any Public/Products liability claims, whether successful or not, against you in the last 5 years?* Yes No You have answered yes to having a proposal being declined or insurance policy cancelled or renewal refused. Please provide more details below* You have answered yes to having a claim against you in the last 5 years. Please provide details below.* HiddenReferral required 2Business DetailsInsured Name (Legal Entity Name)* Telephone*Contact Name* Email* Date of Establishment* DD slash MM slash YYYY Website ABN/ACN*Address of all other locations (if any) from which the insured operates Head Office Address* Physical Street Address of Business (Do not use a PO Box) Suburb State Post Code Details of interested parties to be noted Due to some of your answers, your policy quote will be sent for review. Therefore, we are not able to provide you with a policy quote amount at this time. Your Policy Start Date - Your Quote Your total annual premium based on the provided information is: Save QuoteSave Quote for laterDue to some of your answers, your policy will be sent for reviewPlease read the following advice before proceeding to complete this proposal form:* I have read and understood the IMPORTANT NOTICES and FINANCIAL SERVICES GUIDE Important Notices 1 Important Notices 2 Financial Services Guide Important Notices 1 Important Notices 2 Financial Services Guide I/We declare that the statement and particulars in this proposal form are true and that no material facts have been misstated or suppressed after enquiry. I/We agree that should any of the information given by us alter between the date of this proposal and the inception date of the insurance to which this proposal relates, I/We will give immediate notice thereof. I/We agree that the Underwriters may use and disclose our personal information in accordance with the "Privacy Statement" included in the IMPORTANT NOTICES of this Proposal. I/We agree that this proposal, together with any other information supplied by me/us shall form the basis of any contract of insurance affected thereon.HiddenBroker Declaration I confirm that the answers provided by the Insured are true and correct and shall be the basis of this contract. TO BE SIGNED BY THE INSURED FOR WHOM THIS INSURANCE IS INTENDED FOR* ELECTRONIC SIGNATURE ACKNOWLEDGEMENT Date* DD slash MM slash YYYY Name* First Last It is important the undersigned of the declaration above is fully aware of the scope of this insurance so that these questions can be answered correctly. If in doubt, please contact the broker or agent, since non-disclosure may affect an insureds right of recovery under the policy.Confirmation* I confirm the Start Date of Policy Please allow up to 60 seconds for your policy to be progressed and do not click the next button more than once. Your Policy Start Date - Please note, there is a 1.4% + $0.39 transaction fees that will apply to your purchase.HiddenStripeFeeSelect payment type* Credit Card - Annual amount in full via credit card Please select the relevant payment type to continueRebalance Price Price: $ 0.00 Information Technology Insurance Policy Price: $ 0.00 Subtotal $ 0.00 Total - Information Technology Insurance Credit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Credit Card* Please allow up to 60 seconds for your policy to be submitted and do not click the submit button more than once.HiddenPremium Funding Interest chargeHiddenPremium Funding Interest RateHiddenPremium Funding TotalHiddenInitial InstalmentHiddenPremium Funding InstalmentPremium Funding Details Your first instalment is . There are 11 instalments remaining each of . These are payable monthly on the same day of each month. Premium: Interest Charges: Total Amounts Repayable: No. of Instalments: 12 Interest Rate: % Initial Instalment: Subsequent Instalments: These amounts are only estimates. To see an accurate pricing schedule Hiddenefund link Hiddenefund PDF
