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Name
*
First
Last
Postal Address
*
Street Address
Suburb
State
Post Code
Phone
*
Email
*
Name of the Entity/Person(s) Requesting this Insurance
*
Address/Location for this Fit-Out
*
Street Address
Address Line 2
Suburb
State
Post Code
Please Describe Business Type
*
e.g. Cafe, Restaurant or Food Premises, Office, Medical, Retail Clothing/Sunglasses/Shoes/Electrical etc,
Do you have Council approval?
*
-- Please Select --
Yes
No
No (Not Required)
Do you have consent from the Property Owner
*
-- Please Select --
Yes
No
Are you engaging a Commercial Builder?
*
-- Please Select --
No
Yes
Estimated Time to Complete Fit-Out
*
-- Please Select --
Up to 3 Months
3 - 6 Months
7 - 12 Months
More than 12 months
Cost of Fit-Out Works
*
Please estimate the cost of these works
Please select the Public Liability Limit you require
*
--Please Select --
$ 10,000,000
$ 20,000,000
Existing Structure (i.e. Existing Property Value)
*
Please confirm if the Building Insurer is prepared to cover the building during the fit-out period. If not, you must specify the building replacement value as provided by the Property Owner or Managing Agent.
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