OB Personal Accident & Volunteer Workers Insurance Quote Form

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Please provide as many details as possible to speed up the processing of your request. You should receive your quotation within two business working days!! For faxing, posting or scanning and emailing your quote request, download the PDF version of the Form.

Alternatively, you can submit your quote request online. See below.

Fields marked in bold are mandatory.

Owner Builder Contact Details

Title :

First Name :

Last Name :

Phone (day)* :

Phone (home)* :

Fax* :

Mobile :

Email :

*Please include area code. Example:0283030573

Postal Address

Street Address :

Suburb :

State :

Postcode :

Site Address (Same as Postal Address )

Street Address :

Suburb :

State :

Postcode :

Other Details

Project Type :

specify if Other :

Workers to cover:

Number of workers at any time:

Replacement Cost (?e.g. Total Replacement Cost of work as if carried out by the Builder) :

Insurance From: / /

To: / /

Have you ever made an insurance claim under any accident or sickness or travel policy?

No. Yes. If yes, provide details below:

NOTICE: Before you enter into a contract of general insuance with an insurer, you have a duty, under the Insurance Contracts Act(1984), to disclose to the insurer every matter you know, or could reasonably be expected to know, is relevant to the insurer's decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the insurer before you renew, extend, vary or reinstate a contract of general insurance.
Your duty, however, does not require disclosure of matter:

that diminishes, however, the risk to be undertaken by the insurer

that is of common knowledge

that your insurer knows or, in the ordinary course of its business, ought to know

as to which compliance with your duty is waived by the insurer.

NON-DISCLOSURE: If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce its liabulity under the contract in respect of a claim or may cancel teh contract in respoect if a claim or may cancel the contract. If your non-disclosure is fraudulen, the insurer may also have the option of avoiding the contract from its beginning.
I / We confirm that the answers and statements in this proposal are correct and that no information has been supplied or withheld in breach of the duty of disclosure, which is set out above, nor have I / We misrepresented any information supplied to you, which could affect your acceptance of this proposal all the terms of the policy.

Help us help you by answering this question:

What type of roof do you have?

Also email me a copy of this request. (Requires a valid email.)

To enable us to introduce you to a Service Provider in sending this enquiry, you consent to the disclosure of this personal information to third parties and between related business entities for the purpose for which this information was received and collected, or for related purposes, to provide you with a service that you requested.

After you submit your Quote Request, you will be contacted by one of our Customer Service Officers who will provide you with a quote and assist you with your case.

If you have any urgent questions please don't hesitate to call us on (02) 8303 0545 Monday to Friday 9am to 5pm (AEST).

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