Horticultural Insurance Online Quote Request
Contact Details
First Name:
Last Name:
Trading Name:
Contact Number:
Fax:
Mobile:
Email Address:
Address:
Street Address:
Suburb
State:
VIC
QLD
NSW
NT
SA
WA
TAS
Postcode:
Occupation:
Cover Required:
Liability
Motor
Personal Accident
Tools
( Hold down the shift key and click to select more then one)
Liability
Height limit:
5 Metres
10 Metres
Unrestricted
Limit of liability:
$5 Million
$10 Million
$20 Million
Turnover:
Number of staff (fulltime)::
Industry Experience
Previous insurance
Previous Claims
Motor and Plant
Location:
DOB of regular drivers:
Vehicle Make:
Model:
Vehicle Type:
Truck under 5 tonne
Truck between 5 and 10 tonne
Truck over 10 Tonne
Sedan/Wagon
Woodchipper
Travel Tower
Stump Grinder
Cover Required:
Comprehensive
TPO
Sum Insured/Value:
Modifications
No Claims Bonus
Past Claim Details
Personal Accident
Insured First Name:
Surname:
DOB:
Height (cm):
Weight (kg):
Existing Medical Conditions
Weekly Benefit Required
eg $500 per week
Cover Required:
Accident Only
Accident/Illness
Tools
Sum Insured:
Note: Not intended for mobile plant - refer to motor section.
Claims History:
How Do you prefer to be contacted?
Telephone
Email
Postal Mail
Fax
Additional Comments