LEXi Quick Indication LEXi Instant IndicationTurnover *$0up tp $500,000$500,001 - $1,000,000$1,000,001 - $2,000,000$2,000,001 - $3,000,000$3,000,001 - $5,000,000$5,000,001 - $10,000,000$10,000,001 - $15,000,000$15,000,001 - $20,000,000above $20,000,000Please select turnover bandBase PremiumT/O Exceeding $20mIf the T/O exceeds $20m, we are unable to provide an instant indication. Please also note that if the T/O exceeds $100m, we will be unable to quote. If between $20m and $100m please continue with the form.Please select any Optional Additional BenefitsBuilding & Construction Contracts DisputesDisputes arising out of Building or Construction ContractsConstruction Contracts EPEmployment Contracts DisputesDisputes arising out of Employment ContractsEmployment Contracts EPPersonal cover for EmployeesPersonal Expenses Cover & Free Legal Advice for your EmployeesNumber of Employees *01234567891011121314151617181920Please select the number of employees (must be all or none)Personal Cover EPPlease select Stamp Duty Rate *9%10%11%Total Base PremiumStamp DutyGSTEdge UW Fee (inc GST)TOTALConditionsThis 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 InsuredName of the Insured *Only 1 entity per policy allowedABN *0 / 11Street 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/territoriesPlease provide T/O split by state so that the correct Stamp Duty calculation can be applied *Normal Business Activity *Cover DetailsProposed Inception Date *Proposed Expiry DateFrom and to 4:00pm Local Standard Time at the address of the proposed Insured for a period of 12 months unless requested otherwisePlease 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 EmployeesNumber of Employees *Disclosure QuestionsLoss / 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 costsKnown 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 costsNormal 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 industryPlease provide full detailsInstructions & Broker DeclarationsInstructionsQuote 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 clientAnd that: *The information provided by me is a true, accurate and complete reflection of the answers provided to me by my clientPlease provide any additional comments/requests hereFull name of the Broker completing this form *Broking House *Broker's Email Address *Broker's Phone NumberPlease include area code if not providing mobile numberAre you or your broking house an AR? *NoYesName of Broking House who holds the AFSL *Important InformationA 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).Submit to Edge Click HERE to view the coverage summary
