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Workers Compensation Quote
Name of Entity/Employer
ABN
*
Main business address
*
State
Postcode
Describe your practice
e.g. GP clinic, Radiology practice, Obstetric practice
Estimate director wages for the next 12 months
Estimate employee wages for the next 12 months
Do you currently have workers compensation cover?
No
Yes
Insurer name
Due date
Total annual premium
What date do you need the insurance policy to commence?
Provide any other information you feel is relevant
Your preferred name
Mobile number
*
Email address
*
Preferred contact method
*
Mobile
Email
Preferred time to contact
:
HH
MM
AM
PM
