Public Liability Quote Request

Please complete the questions below and click submit for your public liability insurance quote

Are you an existing Jim's Franchisee or becoming a new Jim's Franchise?

Are you an existing Jim's Franchisee or becoming a new Jim's Franchise? Yes – STOP!! Please go to our home page and click on Jim’s Franchisees No
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone
Email
Company/Trade Name
ABN
Policy Information
What date do your require your policy to start from? What date do your require your policy to start from? / DD / MM YYYY
Please select the level of cover you require:
Current Insurer
What is your Business Occupation / Description?
How many years have you been in business?
Estimated turnover for the next 12 months?
Estimate wages?
How many people work in your business? (Including yourself) This does not included sub-contractors. Any sub-contractor you hire must have their own Public Liability policy and this is your responsibility to check to ensure they have cover.
Questions
1. Do you employ Sub Contractors or Use Labour Hire?

1. Do you employ Sub Contractors or Use Labour Hire? Yes No
Annual Payments
Sub-Contractors $ Dollars . Cents
Labour Hire $ Dollars . Cents
2. Do you export products to USA/Canada?

2. Do you export products to USA/Canada? Yes No
3. Do you enter into any hold harmless agreements or need to note the interest of a third party?

3. Do you enter into any hold harmless agreements or need to note the interest of a third party? Yes No
4. Have you ever had an insurance policy cancelled by the insurer, declined or special terms imposed?

4. Have you ever had an insurance policy cancelled by the insurer, declined or special terms imposed? Yes No
During the past 5 years;
5. Have you been declared bankrupt?

During the past 5 years; 5. Have you been declared bankrupt? Yes No
6. Have you been convicted of a criminal offence?

6. Have you been convicted of a criminal offence? Yes No
7. Have you ever claimed under a Public & Products Liability Insurance Policy?

7. Have you ever claimed under a Public & Products Liability Insurance Policy? Yes No
If yes to any of the above, please provide details; (dates/insurer/ description etc)
Do you have any additional information you wish to provide us with?

Public Liability Quote Request

Public Liability Quote Request

Policy Information

Questions

Annual Payments