$ $ $ $ $ Electronic Breakdown 25. Do you require blanket electronic breakdown cover? Yes No Description of items: $ Public and Products Liability 26. Do you require cover for public and products liability? Limit of indemnity $5,000,000 $10,000,000 $20,000,000 Tax Audit 27. Do you require cover for tax audit? $10,000 $15,000 $20,000 $25,000 $30,000 $40,000 $50,000 28. Do you require self-managed superannuation cover? Yes No General Property 29. Do you require cover for general property? Yes No Unspecified items $2,500/$5,000 $2,500/$10,000 $2,500/$15,000 $2,500/$20,000 30. Please list individual items to be covered including make model & serial number $ $ $ $ $ Interested Party 31. Do you require any interested party to be noted on you policy? Yes No Policy Section Interested Type e.g. landlord Party Claims History 32. In the last 5 years have you suffered any loss or damage which was not covered by Yes No an insurance policy? 33. In the last 5 years have you made any claims to an insurer for loss or damage? Yes No
$ $ $ $ $ Electronic Breakdown 25. Do you require blanket electronic breakdown cover? Yes No Description of items: $ Public and Products Liability 26. Do you require cover for public and products liability? Limit of indemnity $5,000,000 $10,000,000 $20,000,000 Tax Audit 27. Do you require cover for tax audit? $10,000 $15,000 $20,000 $25,000 $30,000 $40,000 $50,000 28. Do you require self-managed superannuation cover? Yes No General Property 29. Do you require cover for general property? Yes No Unspecified items $2,500/$5,000 $2,500/$10,000 $2,500/$15,000 $2,500/$20,000 30. Please list individual items to be covered including make model & serial number $ $ $ $ $ Interested Party 31. Do you require any interested party to be noted on you policy? Yes No Policy Section Interested Type e.g. landlord Party Claims History 32. In the last 5 years have you suffered any loss or damage which was not covered by an insurance policy? Yes No 33. In the last 5 years have you made any claims to an insurer for loss or damage? Yes No
OPP-Proposal-Form-V9.17.docx