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      Public Liability Form

      General Information

      Date format: 01/01/0000
      Format: 00/00/0000

      Business Information

      Please advise the following

      Date format: 01/01/0000

      Turnover Split per state/territory (%)

      %
      %
      %
      %
      %
      %
      %
      %

      Risk

      If yes please complete import/export questions

      Exports

      General History

      After investigation are you or any principal, director or partner aware of:

      Declaration 

      iv. I/we have read and understood the  Financial Services Guide and Privacy Statement;

      This declaration must be completed and signed by or on behalf of the party applying for insurance. I/We

      a) declare that:
      i. the answers and information given by me/us in this Application are true and correct in all respects;
      ii. no information has been withheld that would affect an insurer's decision to accept this Application;
      iii. where answers in this online application have not been completed by myself, they have been checked by me/us and I/we agree they are correct and true;
      iv. I/we have read and understood the  Financial Services Guide and Privacy Statement;
      v. if there was insufficient space to fully answer any questions, I/we have attached supplementary pages providing the additional information required.
      b) authorise National Insurance Group  to give to, or obtain from other insurers or an insurance or credit reference bureau, any information relating to these insurance covers, and any other insurances held by me/us and claims under those insurances.


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    National Insurance Group
    ABN:  94 219 052 354

    Authorised Representative: 1265061
    of McLardy McShane Partners Pty Ltd 
    AFSL No: 232987
    ​ABN: 14 064 465 309
    National Insurance Group endorses the Insurance Brokers Code of Practice. To obtain a copy of the code, click here.


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    Disclaimer :The information provided by National Insurance Group on this website is for general information purposes only, and it is not a substitute for professional advice.  You should always consider the PDS/Policy wording before making a decision.  Coverage may differ based on specific clauses in individual policies.  Refer to the FSG on our website or by requesting a copy for our services and remuneration details.
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