LEXi Quick Indication

LEXi Instant Indication

Turnover *Please select turnover band

Base Premium

T/O Exceeding $20m

If the T/O eceeds $20m, we are unable to provide an instant indication. Please also note that if the T/O exceeds $30m, we will be unable to quote. If between $20m and $30m please continue with the form.

Please select any Optional Additional Benefits

Building & Construction Contracts DisputesDisputes arising out of Building or Construction Contracts

Construction Contracts EP

Employment Contracts DisputesDisputes arising out of Employment Contracts

Employment Contracts EP

Personal cover for EmployeesPersonal Expenses Cover & Free Legal Advice for your Employees

Number of Employees *Please select the number of employees (must be all or none)

Personal Cover EP

Please select Stamp Duty Rate *9%10%11%

Total Base Premium

Stamp Duty

GST

Edge UW Fee (inc GST)

TOTAL

Conditions

This indication is based on the following assumptions:

T/O does not exceed $20m
No of employees (if selectecting Personal cover extension) does not exceed 20
In the last 5 years your client has not been involved in a commercial or legal dispute which incurred legal costs; and
After appropriate enquiry your client is not aware of any matter which may develop into a dispute which is likely to incur legal costs; and
Your client is not a statutory body, union or involved in the: security industry; adult industry; or the tattoo industry

Should you wish to receive formal terms and/or for us to bind, please use the “next” button below to complete sections 2 – 5.

The Insured

Name of the Insured *Only 1 entity per policy allowed

ABN *

0 / 11

Street Address *

Suburb *

State *

Post Code *

Estimated Annual Turnover (next 12 months) *

T/O for S/Duty Purposes *100% of T/O comes from home state/territoryT/O comes from various states/territories

Please provide T/O split by state so that the correct Stamp Duty calculation can be applied *

Normal Business Activity *

Cover Details

Proposed Inception Date *

Proposed Expiry Date

From and to 4:00pm Local Standard Time at the address of the proposed Insured for a period of 12 months unless requested otherwise

Please re-confirm any Additional Optional BenefitsDisputes arising out of Building or Construction ContractsDisputes arising out of Employment Contracts with your EmployeesPersonal Legal Expenses Cover & Free Legal Advice for your Employees

Number of Employees *

Disclosure Questions

Loss / Incident History *In the LAST 5 YEARS the proposed Insured has NOT been involved in a commercial or legal dispute which incurred legal costsIn the LAST 5 YEARS the proposed Insured HAS been involved in a commercial or legal dispute which incurred legal costs

Known Circumstances *After appropriate enquiry, the proposed Insured is NOT aware of ANY matter which may develop into a dispute that is likely to incur legal costsAfter appropriate enquiry, the proposed Insured IS aware of a matter or matters which may develop into a dispute that is likely to incur legal costs

Normal Business Activities *The proposed Insured is NOT: a statutory body, union, or involved in the: security industry; adult industry; or the tattoo industryThe proposed Insured IS: a statutory body, union, or involved in the: security industry; adult industry; or the tattoo industry

Please provide full details

Instructions & Broker Declarations

Instructions

Quote Only or Quote & Bind *Please provide a formal Quote onlyAssuming the premium is as per the indication, please quote & bind and confirm you are on risk

I hereby Declare that: *I have explained the Duty of Disclosure to my client

And that: *The information provided by me is a true, accurate and complete reflection of the answers provided to me by my client

Please provide any additional comments/requests here

Full name of the Broker completing this form *

Broking House *

Broker's Email Address *

Broker's Phone Number

Please include area code if not providing mobile number

Important Information

A full copy of your answers will be automatically emailed to you upon hitting the submit button below. You are welcome to forward this to your client for their signature and for your records if required (we do not require this).

Click HERE to view the coverage summary