Photographic Equipment Insurance Web Quote Request

* Are required fields

Title: *

(Mr, Mrs, Miss, Ms, Dr, etc)

First Name: *

Last Name: *

Company Name:

Address: *

Suburb or City: *

State: *

Postcode: *

Phone: *

Facsimile:

Email: *

Preferred Contact Method: *

EmailPhoneFacsimile

Equipment Details:

Australia Wide Cover -
Sum Insured: *

- A schedule of items is required prior to cover commencing

Studio Only Cover -
Sum Insured: *

- A schedule of items is required prior to cover commencing

Currently Insured? *

YesNo

If yes nominate Insurer
Expiry Date:

Security Details - Situation where the equipment is usually stored

Is this the address shown above?

YesNo

If No, please provide location?

Deadlocks on all doors?

YesNo

Keyed window locks on all windows?

YesNo

Local Alarm System?

YesNo

Monitored Alarm System?

YesNo

Insurance History Details

Insurance previously declined?

YesNo

Previous Insurance Claims?

YesNo

If Yes, Previous claims history?