Apply for Architects Professional Indemnity and Liability

Section 1: Contact Details

* Insured Name:

* Contact:

* Address:

* Telephone Number

Fax:

Web Address:

* Email:

ABN:

Date of Establishment:

Address of any other Business locations:

Section 2. Limits Of Indemnity

Section 3: Business Description

* Please provide a detailed description of your professional business, which is required to be covered by this policy.

Section 4: Employee Information

* Total Number of Staff: * Total Number of Directors: * Total Number of Qualified Staff:

Section 5: Gross Revenue Earned

1. Last financial year’s gross fees:

* AUD $

2. In respect of gross fees for the last financial year, please provide a breakdown by state:

NSW

ACT

QLD

VIC

TAS

SA

WA

NT

Overseas

Total

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Section 6: General Information

* Does the company have operations outside of Australia? Yes No

If Yes, does the company have operations in the USA/Canada? Yes No

If Yes, please provide further details:

Have any Claims been made against the company for Professional negligence, error or omission in the last 5 years? Yes No

If Yes, please provide further details of any Claim, the Claim amount and any payments:

Section 7: Income Breakdown

1.Please provide a breakdown of your gross fees/income by Professional Business for the last financial year by stating the relevant percentage. (Must total 100%)

(a) Architect

(b) Architectural Contract Management

(c) Architectural Drafting

(d) Architectural Heritage

(e) Architectural Interior Design

(f) Architectural Landscaping

(g) Naval Architecture

(h) Architectural Project Management

(i) Building Designer

(j) Other (Please specify)

Total

2. Please indicate the percentage of the firm’s income derived from the following job categories. (Must total 100%)

(a) Domestic Building (Excluding Flats/Units/Town Houses)

(b) Commercial Buildings (Including Flats/Units/Town Houses)

(c) High Rise Buildings (Exceeding 3 floors and not otherwise specified)

(d) Institutional Buildings (Ecclesiastical/health/educational)

(e) Feasibility Studies (where not involved in design/construction)

(f) Soil Testing/Surveys of Sub – Surface condition

(g) Town Planning

(h) Other (Please specify)

Total

Thank you for your submission.
A representative will contact you within 24 hours with your Quotation.