Mining Quote

Regional Insurance Brokers are specialist in mining insurance, and can tailor your insurance package to suit your specific needs. To receive a free quote of the mining insurance policies we can find for your business, please fill out and submit the form below.

A Regional Insurance broker will contact you.

Choose your state

1. Liability Insurance

Your Trade*

Specify Trade*

Amount*

Number of Employees*

Annual Turnover

Sub Contractors*

Companies*

2. Professional Indemnity

Sum Insured*

Annual Fees generated from services provided*

4. Your Details

Name*

Email*

Phone*

Insured Name(s)*

ABN

Address*

Date of Birth

Mobile

Work Phone

Fax

Period of Insurance*

to

3. General Questions

If you answer “Yes” to any of the following, we will not be able to give you an online quoatation, instead, our staff will contact you to further discuss your case.
Have you (in the past 5 years)…

1. Made any claim(s) on an insurer for loss or damage?

YES NO

2. Had any insurance decline or cancelled, application rejected, renewal refused, claim rejected, Special conditions or excess imposed ny an insurer?

YES NO

3. Suffered any loss or damage which would have been covered by the proposed insurance policy?

YES NO


Have you or any partner(s), shareholder(s) or director(s) of the business…

4. Ever been declared bankrupt?

YES NO

5. Ever been involved in a company or business which became insolvent or subject to any form of insolvency administratrion (e.g. liquidation or receivership)?

YES NO

6. Been convicted of any criminal offence within the past 5 years (Other than minor traffic convictions)?

YES NO

7. Been liable for any civil offence or pecuniary penalty (exceeding $5,000)?

YES NO

5. Declaration

I have read and understood the important information and the policy wording. I declare that the information given is true and correct in every particular and all details relevant to this insurance have been disclosed. I understand that even if I have paid a premium, this cover will not be effective until the Underwriter has accepted the insurance application and the policy certificate issued.

Submission Status