• (08) 6147 3200
  • ultra@uis.com.au
  • Ultra Insurance Solutions
  • Home
  • Obtain a Quote
  • 2Quote Form Business Pack
  • Contacts
  • Situation at Risk
  • Property Details
  • Insurance Options
  • Insurance History
  • Additional Information

Contacts

Previous

Additional Contacts

Additional Contacts #1

 
+ Additional Contacts

Business Details

Previous

Situation at Risk

(Cannot be a PO Box)

Business Occupation

$
$

Property Details

Insurance Options

Fire and Perils/Property Damage - Additional questions

$
$
$

Business Interruption - Additional Questions

$
$
$
$
$

Public/Products Liability - Additional Questions

$
$

Theft - Additional Questions

$
$
$
$
$

Money - Additional Questions

$
$
$
$
$
$

Glass - Additional Questions

General Property - Additional Questions

$
DescriptionSum insured
$

Machinery Breakdown - Additional Questions

Type of unitSum insured
$
$

Electronic Equipment - Additional Questions

$
$
$

Goods in Transit - Additional Questions

$
$

Tax Audit - Additional Questions

$

Insurance History

In the last 5 years have you

Claims History

InsurerClaim dateType of claimAmount paidFinalizedDescription
$

Additional Information

$
$
Privacy Policy   Complaints & Disputes  Code of Practice  FSG

Ultra Insurance Solutions Pty Ltd CAR 240699 | ABN 33 006 500 072
Corporate Authorised representative of Community Broker Network Pty Ltd | AFSL 233750 | ACN 096 916 184