Quote Request - Webber Insurance Forms

Accountant Insurance Quote Request

1Your Information

2Business Activities

3Business Details

4Cover Required

5Declaration

X/Twitter

This field is for validation purposes and should be left unchanged.

Fortix ID Opportunity

Work Request ID

Existing Opportunity

Your Information

Name(Required)

First Last

Company Name

ABN

Best Contact Number(Required)

Email(Required)

Website

Please ensure that your website includes https:// to submit the form correctly.

Main Business Address(Required)

Street Address City State Post Code Country

Do you have any other business locations?(Required)

Yes

If yes, please provide further details(Required)

Business Activities

Type of Accounting work the Firm has undertaken in the PAST 12 months?(Required)

Accounts Preparation

Auditing

Bookkeeping

Taxation

BAS

Business Valuations

Superannuation Fund Management / Trusteeship / Administration

Forensic Accounting

Management Consultancy

Company Directorships

Business / Mortgage / Finance Broking

Financial Planning, Investment Advice / Management

Mergers and Acquisitions

Receivership's, Liquidations or Insolvencies

Other

If a new business, please provide estimates for next 12 months

Percentage of Accounts Preparation work(Required)

Overall percentage of Auditing work?(Required)

Type of Auditing work undertaken(Required)

Public Listed Companies

Public Unlisted Companies

Small Private Companies

Large Private Companies

Non Profit Organisations

Financial Institutions

Trust Funds and/or Executorships

Superannuation Funds (General)

Self Managed Super Funds

Other

Percentage of Public Listed Companies work(Required)

Percentage of Public Unlisted Companies work(Required)

Percentage of Small Private Companies work(Required)

Percentage of Large Private Companies work(Required)

Percentage of Non Profit Organisations work(Required)

Percentage of Financial Institutions work(Required)

Percentage of Trust Funds and/or Executorships work(Required)

Percentage of Superannuation Funds (General) work(Required)

Percentage of SMSF work(Required)

Percentage of Other work(Required)

If other, please provide further details(Required)

Please provide an overview of your 5 largest audit clients(Required)

Please provide Business Names, Nature of Business and Annual Fees

Percentage of Bookkeeping work(Required)

Percentage of Taxation work(Required)

Percentage of BAS work(Required)

Percentage of Business Valuation work(Required)

How many valuations do you undertake per annum?(Required)

Please provide details and qualifications of Principals or Staff that undertake business valuations(Required)

What type of valuations do you provide?(Required)

Business Valuations

Valuations of Equity in Business

Profitability Assessments

Pre-Purchase Reviews

Other

Tick all that apply

If other, please advise further details(Required)

Please provide an overview of the purpose of these valuations along with whom they were done for in the past 12 months?(Required)

Percentage of Superannuation Fund Management / Trusteeship / Administration work(Required)

Is the Superannuation Fund for the benefit of the Firm's Principals or Staff?(Required)

Yes

Is the Superannuation Fund invested at the discretion of the Firm for Principals or Staff?(Required)

Yes

If yes, where is it invested?(Required)

Is the Superannuation Fund for the benefit of the Firm's Clients?(Required)

Yes

Is the Superannuation Fund invested at the discretion of the Firm for Clients?(Required)

Yes

If yes, where is it invested?(Required)

Do the Firm's clients have knowledge of the type of investment in the Fund/s and formally confirm their acceptance?(Required)

Yes

Does the Firm manage the funds by way of a trust account to be passed onto a recognised fund at the clients' direction?(Required)

Yes

Has the Firm established predetermined investment criteria with the clients?(Required)

Yes

Do any Partners, Principals or Staff act as Trustees of any clients' Superannuation Funds?(Required)

Yes

If yes, please provide further details(Required)

Percentage of Forensic Accounting work(Required)

Percentage of Management Consultancy work(Required)

Please elaborate on the nature of activities undertaken and advice given to clients(Required)

Percentage of Company Directorship work(Required)

Please provide further details including Company details, Position and Length of Time involved(Required)

Percentage of Business / Mortgage / Finance Broking work(Required)

Percentage of Financial Planning, Investment Advice / Management work(Required)

Percentage of Mergers & Acquisitions work(Required)

Percentage of Receivership's, Liquidations or Insolvencies work(Required)

Percentage of Other work(Required)

Please provide further details of your Other activities(Required)

Changes to Business Activities

Will there be any known significant changes to your business activities for the NEXT 12 months?(Required)

Yes

Other

If yes, please provide further details(Required)

Have you ceased providing any of the above services in the past 5 years?(Required)

Yes

If yes, please provide further details(Required)

If other, please provide further details(Required)

Fidelity

Optional Covers

About Your Business

Number of Staff (including Directors)(Required)

Details of key staff employed (including Directors) who carry out professional services(Required)

Please include name and qualifications held

Is all work signed off by a qualified principal or partner(Required)

Yes

If no, please detail why not and the risk management procedures in place to deal with technical staff errors(Required)

Do you engage any Consultants or Contractors to do any work on behalf of your firm?(Required)

Yes I do

No I don't

I am unsure

If yes, please provide further details as to the nature of work undertaken by these Contractors or Consultants(Required)

Do you require each Contractor, Sub-Contractor or Consultant to have their own Professional Indemnity cover in place?(Required)

Yes we do

No we dont

I am unsure

Does any contract or client represent more than 25% of your annual work?(Required)

Yes

I am unsure

If yes, please provide further details(Required)

What are the Gross Professional Fees paid to these Contractors, Sub-Contractors or Consultants?(Required)

Do you always obtain your client's signed retainer agreement?(Required)

Yes I do

No I don't

I am unsure

If no, by what other means do you record your retainer?(Required)

Do you always provide written advice (including valuations/assessments) with appropriate disclaimers?(Required)

Yes

If no, by what other means do you record your advice?(Required)

Do you require Insurance cover for your Consultants & Contractors?(Required)

Yes, for all of them

Yes, for some of them

No I don't

I am unsure

Please provide further details regarding the Contractor/s &/or Consultant/s that need Insurance cover.(Required)

Fee Information

Please provide your total Gross Fees (ex GST) over the PAST 12 months(Required)

Gross Fees (Ex GST) should include an estimate of all income received for your professional services including fees that are on-paid to Sub-Contractors. If it is a new business please enter $0 or new business.

Please provide your estimated total Gross Fees (ex GST) for the NEXT 12 months(Required)

Gross Fees (Ex GST) should include an estimate of all income received for your professional services including fees that are on-paid to Sub-Contractors. If it is a new business and are unsure, please provide a rough estimation.

What states do you receive your fees from?(Required)

NSW

VIC

QLD

TAS

ACT

USA / Canada

Other Overseas

*Please ensure that this field totals 100%. This split is required to calculate the correct Stamp Duty on your insurance policy, and is intended to be an estimate only of where you derive your income from.

Percentage of fees received in NSW(Required)

Percentage of fees received in VIC(Required)

Percentage of fees received in QLD(Required)

Percentage of fees received in WA(Required)

Percentage of fees received in SA(Required)

Percentage of fees received in TAS(Required)

Percentage of fees received in NT(Required)

Percentage of fees received in ACT(Required)

Percentage of fees received in NZ(Required)

Percentage of fees received in USA / Canada(Required)

Percentage of fees received in Other Overseas(Required)

If Other Overseas, please provide further details including countries fees received from(Required)

NSW Stamp Duty Declaration

Are you a small business Individual / Partnership / Company and/or Trust, which is carrying on a business, and the business has an aggregated turnover of less than $2 million(Required)

YES, my business turnover is LESS than $2,000,000

NO, my business turnover is GREATER than $2,000,000

Aggregated turnover is your Australia wide annual turnover plus the annual turnovers of any business entities that are your affiliates or are connected with you.

Click here to read more about this exemption

Additional Business Information

Is your business domiciled in Australia?(Required)

Yes

If no, please provide country where business is domiciled(Required)

Have you ever changed the name that you trade under(Required)

Yes

If yes, please provide further details(Required)

Have you ever merged with or purchased another practice(Required)

Yes

If yes, please provide further details(Required)

Do you envisage any substantial changes to your activities or are there any new major operations being contemplated in the next 12 months?(Required)

Yes

If yes, please provide further details(Required)

Is any Partner, Principal or Director connected or associated (financially or otherwise) with any other business?(Required)

Yes

If yes, please provide further details(Required)

Do you require cover for any principals in respect of their previous business/es?(Required)

Yes

If yes, please provide further details(Required)

Limits of Cover

Are you currently insured?(Required)

Yes

Current Policy Expiry Date

Current Insurer

What limit of Professional Indemnity cover do you require?(Required)

$1,000,000

$2,000,000

$5,000,000

$10,000,000

$20,000,000

Other

If other, please advise limit required(Required)

What limit of Public Liability cover do you require?(Required)

None

$5,000,000

$10,000,000

$20,000,000

Other

If other, please advise limit required(Required)

Do you require cover for any of the following extensions?(Required)

Fidelity

Previous Business

Outgoing Principals

Public Liability

NONE OF THE ABOVE

Has the business sustained any loss through the fraud or dishonesty of any employee?(Required)

Yes

Is any member of your staff allowed to handle cash or transferable documents or sign cheques on his/her signature alone?(Required)

Yes

Do you always require and obtain satisfactory references when engaging employees?(Required)

Yes

If yes, please provide further details(Required)

Please provide details, including Retirement Date, of Partners, Directors or Principals who have retired and require this extension.(Required)

Please provide further details regarding the previous business(es) that need to be covered under this policy(Required)

Other Insurances

Do you require a quote or additional information on any other insurances?

Office / Contents Insurance

Management Liability Insurance

Cyber / Privacy Protection Insurance

Motor Vehicle Insurance

Drone Insurance

Income Protection / Life Insurance

Construction / Contract Works Insurance

Tools / Mobile Equipment Insurance

Home Insurance

Other Insurance

No thanks

If other, please provide further information(Required)

Claims Experience

The term YOU in the questions below relates to your Firm, Company or you as a Sole Practitioner including present or former Partners, Directors, Principals, Consultants, or Employees.

During the past ten years has any claim been made, or has liability for an error or breach of duty been alleged against YOU; or have any circumstances been notified to insurers which may result in a claim?(Required)

Yes

If Yes, please provide further details(Required)

Are YOU, AFTER FULL INQUIRY, aware of any circumstances which may give rise to a claim?(Required)

Yes

If Yes, please provide further details(Required)

Have YOU ever been subject to disciplinary proceedings for professional misconduct, any enquiry or audit?(Required)

Yes

If Yes, please provide further details(Required)

Has any insurer ever declined to offer Insurance of any type or imposed special terms for YOU?(Required)

Yes

If Yes, please provide further details(Required)

Has any insurer ever cancelled or voided any Insurance held by YOU?(Required)

Yes

If Yes, please provide further details(Required)

Is any partner/director/principal/employee connected or associated (financially or otherwise) with any other Practice or Business?(Required)

Yes

If Yes, please provide further details(Required)

Have YOU been charged with or convicted of any criminal offence?(Required)

Yes

If Yes, please provide further details(Required)

Have YOU been declared bankrupt, insolvent, had a liquidator appointed or been a defendant in any civil court case?(Required)

Yes

If Yes, please provide further details(Required)

Important Information

Please take a moment to read this important information prior to submitting your form.

Duty of Disclosure

1. Your Duty of Disclosure

Before you enter into a contract of general insurance with an insurer, you have a duty, under the Insurance Contracts Act 1984, to disclose to the insurer every matter that you know, or could reasonably be expected to know, that 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 does not require disclosure of any matter:

that diminishes 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, or
as to which compliance with your duty is waived by the insurer.

2. Non-Disclosure

If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce its liability under
the contract in respect of a claim, or may cancel the contract.

If your non-disclosure is fraudulent, the insurer may also have the option of voiding the contract from
its beginning.

3. Claims Made Insurance

This policy may have an Errors and Omissions section. If selected, cover is placed on a claims made basis.
This means that claims first advised to you, or made against you, and reported to your insurer during the
period of insurance are recoverable irrespective of when the incident causing the claim occurred, subject
to any applicable retroactive date.

Under Section 40(3) of the Insurance Contracts Act 1984, if you give written notice to the insurer of facts
that might give rise to a claim against you as soon as is reasonably practicable after you become aware of
those facts, but before the policy expires, then the insurer is not relieved of liability for the claim, when made,
only because it was made after the expiration of the period of insurance.

4. Retroactive Liability

The policy may be limited by a retroactive date stated in the schedule. The policy does not provide cover for any claim arising from any actual or alleged act, error, omission, or conduct that occurs before the commencement of the policy, unless retroactive liability cover is extended by underwriters.

5. Liability Assumed Under Agreement

Liability insurance provided by this policy does not cover liability that you have agreed to accept, unless you would have been liable in the absence of such agreement.

6. Utmost Good Faith

In accordance with Section 13 of the Insurance Contracts Act 1984 (Cth), the policy of insurance is based on utmost good faith, requiring underwriters and the proposer or insured to act toward each other with the utmost good faith in respect of any matter relating to the insurance contract.

Your duty of disclosure also applies when you seek to renew, extend, alter, or reinstate a policy.

If you are unsure whether information needs to be disclosed, please contact our office.

I agree to the Duty of Disclosure

I undertake to inform insurers of any material alteration to these facts, whether occurring before or after completion of the contract of insurance.

Please scroll to the end to tick the boxes.

Important Documents

Please read each document, then confirm below.

Click to read our Privacy Policy
Click to read our Financial Services Guide
Click to read our Terms of Engagement

I declare that I have read the important notices above and understand these notices.

I acknowledge that the insurance cover may be provided in whole or in part by overseas insurers.

Additional Information

Is there any other information that you need to provide to the insurer?(Required)

YES there is

NO there is not

If yes, please provide further information(Required)

How did you hear about Webber Insurance?(Required)

Web Search

Referred by Someone

An Association

TradieWives

Social Media

I am a Previous Client

Existing Client

Other

If other, please advise(Required)

We appreciate referrals. Please let us know who provided you with our details(Required)

Signature

This electronic signature will be treated the same as if signed personally.

Signature

Your Name
Your Name
Your Name