Skip to content
Primary Menu
Home
About
Our Advisors
Risk Management
Insurance
Business/Rooms Insurance
Cyber Risks
Management Liability
Medical Indemnity
Practice Indemnity
Workers Compensation
News and Articles
Contact Us
Management Liability Quote
Name of entity
ABN
*
Type of entity
Pty Ltd
Trust
Partnership
Sole trader
Other
Other entity
Main practice address
*
State
Postcode
Describe the business
When did/will the practice commence trading?
Estimated gross revenue for the next 12 months?
Directors
Name
Qualification
Total number of employees
Do you engage doctors as independent practitioners?
No
Yes
Number of independent practitioners
Do you have a formal contract in place drafted by lawyers which ensures they are classified as independent practitioners and not as employees?
Yes
No
Have you ever had management liability claims, or had an incident occur which would have been covered by management liability?
*
No
Yes
Number of claims
Total paid by insurer
Describe the claim/s
Your preferred name
Mobile number
*
Email address
*
Preferred contact method
*
Mobile
Email
Preferred time to contact
:
HH
MM
AM
PM
