This is a quick intake form to determine if your company has adequate insurance in place to protect your business activities, or alternatively, reduce costs if you're "over insured". Our brokerage team will review this for you free of charge, and if we think we can develop a better overall package we'll put forward a no obligation proposal for you to review.
Company name
*
URL
*
Name
*
First Name
Last Name
Email
*
Phone Number (optional)
Please enter a valid phone number.
Types of insurances in place
*
Management Liability / D&O
Professional Idemnity
General & Product Liability
Cyber insurance
Workers compensation
Freight & Logistics
Other
Coverage limits
*
Please Select
Unsure
$1M+ on most lines
$5M+ on most lines
$10M + on most lines
Any particular risks or concerns that you'd like to mitigate?
*
Is this time sensitive?
Yes, need sorted ASAP.
No, we have some time.
Approximate amount paid on insurance per year
*
Satisfaction with existing broker (optional)
1
2
3
4
5
Coverage documents (Wordings, policies, contracts, tender documents, ASIC requirements etc you'd like us to analyse) this gives us good insight into best types of coverage to recommend.
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If we can find a better solution would you be happy to shift to UpSure?
*
Yes
No
Let's see :)
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