If you require assistance in completing this
application please call us on 1300 464 989
MANAGEMENT LIABILITY INSURANCE APPLICATION
Total Annual Revenue $
Please state the total number of employees including self:
Do you have written employment practices procedures that are available to each employee?
PLEASE NOTE: EPL DEDUCTIBLE OF $25,000 WILL APPLY
Main Business Activity
Select from dropdown list
Agricultural / Aquaculture / Winery
Cafes and Restaurants
Chemicals and chemical related services
Community and Social Service(Welfare/Child Support)
Computer/Internet/Software & Hardware Consultancy
Construction / Property Development
Design / Town Planning Architecture
Distribution (including importing and exporting)
Education (including Day Care Centres)
Energy Storage, Transportation technologies
Excavation / Demolition
Farming (Agricultural and Animal)
Food & Beverage manufacture and preparation (including Alcoholic beverages)
Golf Club (not covering professionals or sponsored players)
HR and Management consulting
Human Resources / Recruitment Agencies
Laundry and cleaning services
Legal Services / Solicitors / Lawyers / Barristers
Leisure (including Sports, Tourism and Recreation)
Licensed Professionals (excl. AFSL holders)
Manufacturing (including Warehousing and Distribution /Wholesale)
Media (including Art, Music & Entertainment)
Not for Profits - not including charities
Professional Services Firms
Real Estate & Property Management
Retailing (not including Jewellery store) & Wholesaling
Service Related (including customer service, call centres and beauty therapy)
Technology Providers (except ASP, ISP, Cloud Service Providers, Portals)
Trade Services (metal, wood, electrical and automotive)
Transport and Storage
In respect of income earned for the current financial year, please provide a breakdown by State:
Total must be 100%
Crime / Fidelity Controls
Are countersignatures required on all cheques?
Are dual authorities required for all funds transfers?
Is dual authorisation required for any changes to your master creditors list?
Is an inventory check undertaken and reconciled by a person who does not participate in the inventory check?
Social Engineering Fraud
Do you verify new customer or supplier bank account information (including name, address and bank account number) prior to initiating any financial transaction with such supplier or customer?
Do you have callback procedures with customers or suppliers to authenticate any fund transfer instructions greater than $50,000 prior to transfer?
Do you upon receipt of any email requests to change supplier or customer bank account details (including account number, email address, contact information, bank routing number) have direct callback procedures in place (i.e. other than responding via email) to the contact phone number in place prior to receipt of the change request?
Promotional Code (if relevant):