General Liability Proposal Form

  • Home
  • /
  • General Liability Proposal Form

Unicorn Risk Services Pty Ltd
A.B.N. 32 116 745 209
PO Box 43, Miller NSW 2168
Direct Phone: (02) 9630 4812 or Office Phone: (02) 9630-8788
Direct Fax: (02) 9630 1707 or Office Fax: (02) 9630-0648
(Incorporating professional indemnity & directors and officers liability)
General Liability Proposal Form
(public and products liability)

The purpose of this Proposal Form is to set out all relevant information for submission to the proposed insurers.
Under the Insurance Contracts Act 1984, you are under a duty to make full disclosure in this Proposal Form as follows:-

Important Notices
This programme is operated by Professional Insurance Brokers (NSW) Pty Ltd AFSL: 241251 (ABN: 32 003 068 540 in conjunction with Unicorn Risk Services Pty. Ltd. (Authorised Representative).

Notice to Intending Insured
The Insurance Contracts Act 1984 came into operation on the 1st January, 1986.The provisions of the Act are very important to all parties to any contract of insurance or proposed contract of insurance (“the contract”). Some of them require Insurers to provide certain notices, documents and information to the insureds. After reading this, if any matter relating to the policy wording or proposal is unclear to you or you have any questions at all in relation to the insurance, please contact us for an answer or explanation as soon as possible.

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, 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:-

1. That diminishes the risk undertaken by the insurer;
2. that is of common knowledge;
3. That your Insurer knows, or in the ordinary course of his business, ought to know; and
4. As to which compliance with your duty is waived by the Insurer.

Consequence of 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 avoiding the contract from its beginning.

Underinsurance / Co-insurance / Average
The classes of Insurance listed below contain provisions as to average or underinsurance, This means the insurer requires You to insure for the full value or maximum potential risk. If You do not do so, and You are underinsured, they will pay You less in the event of a claim, calculated by a formula which takes account of the degree of underinsurance. Some Classes of insurance containing underinsurance clauses are:

Fire, Householders / House owner’s, Loss of Profits, Home Unit / Strata, Industrial Special Risks, Contractors Plant & Machinery, Business Pak, Machinery Pak, Land Pak, General Property.

Some Householders / House owner’s policies do not contain a provision as to underinsurance, in which case this notice regarding underinsurance does not apply. Please check your policy wording.

Other Parties’ Interest
This contract only covers the interest in the property of the Named Insured and does not extend to cover the interest of any Third Party in such property, unless otherwise specified in the Schedule.

Claims Made Policy
Your policy may be written on a “claims made” basis. This means that it only covers claims made against you and notified to the insurance company(s) during the period of insurance. However, provided that you give the insurance company(s) notice of any circumstances that may give rise to a claim against you, immediately you become aware of those facts, and during the period of insurance, then this insurance will respond, notwithstanding that no claim has actually been made against you during the period of insurance. If you are unsure as to whether your policy is “claims made” or not please contacts us for clarification.

Hold Blameless / Waiver of Rights / Subrogation
You are warned that should you become a party to any agreement that has the effect of excluding or limiting your Insurer’s chance of recovery from a Third Party, your Insurers may have the right to refuse to indemnify you for such loss where it is shown that your Insurer’s rights of recovery have been prejudiced by your action.

If a cover is cancelled before the expiry of the period of insurance, we will refund to you only the net return premium which we received from the insurer. We will not refund any part of the brokerage we receive for arranging the cover.

Insurance Brokers Dispute Facility
Clients who are not fully satisfied with our services should contact our Customer Relations/Complaints Officer. We subscribe to the Insurance Brokers Dispute Facility (IBDF), a free customer service, and the General Insurance Brokers Code of Practice. Further information is available from this office.


1. Unless otherwise stated the cover granted together with the terms and conditions of the insurance are all as set out on the insurers Standard Policy, a copy of which is available.
2. Receipts will only be issued if requested.
3. This Certificate provides cover as defined only for the party or parties shown as “insured”. The interest of any other party should be notified to us and confirmed in writing.



No part of the Combine Liability Proposal Form may be reproduced by any process without the written permission of Unicorn Risk Services Pty Ltd.



    SECTION 3 - CLAIMS HISTORY OF ASSOCIATION in respect of Association Liability (Professional Indemnity, Directors & Officers), Public & Products Liability


    If yes, please supply details:

    Association Liability

    Public & Products Liability

    Directors & Officers

    Professional Indemnity


    Expiry Date

    Limit of Indemnity(Sum Insured)


    SECTION 5 - Employment Practices Liability Entity Cover (Optional Extension- ONLY Complete If You Have Employees)

    The Declaration

    I/We the undersigned authorised Insured Persons, after enquiry declare as follows:

    1) I am/We are authorised by each of the other applicants to make this proposal.

    2) I/We have read and understood the Notice of the Proposed Insured on the front of this proposal.

    3) I/We have read this proposal and the accompanying documents and acknowledge the contents of the same to be true and complete.

    4) I/We understand that, up until a contract of insurance is entered into, I am/We are under a continuing obligation to immediately inform Insurers of any change in the particulars or statements contained in this proposal or in the accompanying documents.

    Although the signing of this proposal does not bind the applicants to effect insurance, the applicants acknowledge that the particulars and statements contained in this proposal and in the accompanying documents shall be the basis of the contract should a policy be issued, and further, the applicants acknowledge that the proposal and the accompanying documents will be incorporated in the policy.