Information and Quotes Workers Compensation

Complete the questionnaire below and submit it to us and we'll contact you to arrange a quotation.

First Name:
Surname:
Business Name:
ABN:
What industry do you work in
How many people do you employ
What are the annual estimated wages you will pay
Do you engage any sub contractors	Yes No
If you engage sub contractors do you make sure they carry their own Workers Compsation by sighting a certicifate of Currency	Yes No
Do you currently have Workers Compensation insurance	Yes No
Have you ever had Workers Compensation insurance	Yes No
Have you had any claims for Workers Compensation	Yes No
Address:
Postcode:
Telephone:
Fax:
Email:

Workers Compensation Insurance Checklist