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Contact

Business Quote Request

Tick the boxes of the insurance cover you need. Click NEXT and only get asked questions relevant to your needs.
- Select All
- Fire & other specified perils
- Business Interruption
- Burglary
- Money
- Glass
- Liability
- Transit
- Electronic Computer Breakdown
- Machinery Breakdown
- General Property
- Tax Audit
- Employee Fraud
- Motor Vehicles
- Domestic/Residential

Thank you for your interest, now tell us who this enquiry is for?
For us to provide the best response to your inquiry please complete the following*
- This inquiry is for an existing business with current insurance
- This inquiry is for an existing business without insurance
- This inquiry is for a new business

Let's get started with your personal information?
Name*
First Last
Email*
Telephone*
Address*
Street Address

Tell us about your Business
Name of the business*
Describe your business
What is the required start date of the insurance?
DD slash MM slash YYYY
Is your business premise address different to your contact address?*
- Yes
- No
Business Address*
Street Address
Does your business operate from multiple sites?*
- Yes
- No

Can you give more information about the building where your business is operated?
Age of building in years
What is the roof made of?*
- Tile
- Steel
What are the walls made of?*
- Brickwork
- Concrete
- Steel on steel
- Steel on wood
What are the floors made of?
- Timber
- Concrete
What type of alarm system is installed?*
- Monitored
- Local
- None

Tell about Fire & other specified perils
Sum Insured
Building $
Stock $
Contents $
Others (please specify}
Description $

Business Interruption
Indemnity Period
- 6 months
- 12 months
Sum Insured
Gross Profit $
Increased Working Cost $
Wages $
Rent $
Other $
Other Description
Total $

Burglary
Sum Insured
Contents $
Stock $
Tobacco $
Combined contents / stock $
Other $
Other Description

Money
Sum Insured
In Transit $
On Premises $
On premises outside $
Business hours $
In Safe $
Personal custody $
Other $
Other Description

Glass
Sum Insured
Internal or External
- Internal - Replacement Value
- External - Replacement Value
Signs $

Liability
Sum Insured
Payout
- $5 Million
- $10 Million
- $20 Million
Turnover $
Wages Paid $
Staff Numbers $
Are you the property owner?
- No
- Yes
Describe tenant's business
Do you import products?
- No
- Yes
Product 1
Country of origin 1
Product 2
Country of origin 2
Country of origin 3
Product 3

Transit
Own Vehicles
Maximum Value per load $
Annualised Total Carry $
Number of Vehicles #
Professional Carriers
Maximum Value per load $
Annualised Total Carry $

Electronic Computer Breakdown
Describe equipment you wish to insure
Sum Insured $

Machinery Breakdown
Sum Insured
Refrigerator
Amount of units
Units $
Air Conditioner
Amount of units
Units $
Other
Amount of units
Units $

General Property
Describe equipment you wish to insure 'away from your business' (e.g. laptop computers)
Sum Insured

Tax Audit
Sum Insured $

Employee Fraud
Sum Insured $

Motor Vehicles
Make and model
Year
Registration Number
Main Driver
Date Of Birth
DD slash MM slash YYYY
The vehicle is garaged
- No
- Yes
Garage postcode
NCB rating or rating number
Use
- Business
- Private
Under Finance
- No
- Yes
Prior to the Insurer accepting any risk they will require information about any claims over the past 5 years where the claims relate to the type of insurances you wish to take out. Please describe those claims:

How would you prefer us to contact you?*
- Phone
- Email
Email A Copy To Me
- Tick for yes
Name
This field is for validation purposes and should be left unchanged.

PCIB Details

Unit 24, Commercial Court
130 Kingston Road
Underwood QLD 4119
Australia

Phone: (07) 3808 3425
Fax: (07) 3808 3953
admin@pcibroker.com.au

General Info

Gary Goodson and Company Pty Ltd T/as PCIB (Peter Collins Insurance Brokers)
ABN: 23 072 946 055
AFSL: 243509

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