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  • Marine Cargo
    Removal Household Effects Thank you for considering our on line marine cargo or carriers insurance quote service Brokers National has accounts with most insurers and underwriting agencies We aim to find you the best marine cargo or carriers insurance deal possible Please fill in the following form answering all questions then either 1 Click on Email to Brokers National at the bottom of this form OR 2 Highlight this form to Print It and then Fax It to our office on 03 9791 6633 Use the Mouse or the Tab key to move to the next field We will respond with quotes as soon as they have been received from our insurers Freight Cargo Goods In Transit Description of items all goods to be insured including their values The transit is Local Import Export Method of packing Estimated Annual Carry Select Basis Of Calculation Annual Cargo Sendings Gross Freight Earnings Specified Item s Basis of valuation Select Valuation Type Imports CIF 10 Duty Exports CIF 10 Invoice Cost Freight Replacement Value Indemnity Value Less Depreciation Limit anyone load or transit per load Goods are in transit From To Radius of operations From Base Kilometres Registered Numbers of vehicles to be insured Is a Consignment Note used Yes No Method s of transport road rail air post sea Select Transport Type By Road Professional Carrier By Road Own Vehicles By Sea Air Rail Road By Road Only Any Vehicle Conditions requested Select Cover Required All Risks ICCA Fire Flood Collision Overturning Above Perils Plus Accidental Damage Specified Events Specified Events Plus Theft Above Perils Plus Theft Loading Unloading Excess amount preferred Insurance History Details Present insurer Present cover expiry date Current conditions Current rates Current excess Annual Declaration Subject To Insurer Audit Turnover or Sendings or Earnings current year Turnover or

    Original URL path: http://www.brokersnational.com.au/MARINECARGOTRANSIT.htm (2013-02-03)
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  • Trauma Recovery
    recovery insurance quote service Brokers National has accounts with most insurers and underwriting agencies We aim to find you the best trauma recovery insurance deal possible Please fill in the following form answering all questions then either 1 Click on Email to Brokers National at the bottom of this form OR 2 Highlight this form to Print It and then Fax It to our office on 03 9791 6633 Use the Mouse or the Tab key to move to the next field We will respond with quotes as soon as they have been received from our insurers Trauma Recovery Optional Income Protection Business Expenses Life TPD Personal details Your Name Gender Male Female Date of birth Do you smoke Yes No Occupation Duties Work You Do Responsibilities Any recent Health problems In addition to trauma recovery optional covers are also available Trauma Recovery protection Sum insured Optional Term Life protection Sum insured Optional Total Permanent Disablement Sum insured If you are also seeking income protection Monthly gross salary before tax per month Monthly cover maximum 75 of salary per month Waiting period requested days 14 30 Recommended 90 Excess Cover period in years Accident Sickness 2 2 5 5 60

    Original URL path: http://www.brokersnational.com.au/trauma_recovery.htm (2013-02-03)
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  • Group Accident
    you the best group accident insurance deal possible Please fill in the following form answering all questions then either 1 Click on Email to Brokers National at the bottom of this form OR 2 Highlight this form to Print It and then Fax It to our office on 03 9791 6633 Use the Mouse or the Tab key to move to the next field We will respond with quotes as

    Original URL path: http://www.brokersnational.com.au/GROUP_ACCIDENT.htm (2013-02-03)
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  • Keyman
    Optional Covers Thank you for considering our on line keyman insurance quote service Brokers National acts as multi agent for life risk products We aim to find you the best keyman insurance deal possible Please fill in the following form answering all questions then either 1 Click on Email to Brokers National at the bottom of this form OR 2 Highlight this form to Print It and then Fax It to our office on 03 9791 6633 Use the Mouse or the Tab key to move to the next field We will respond with quotes as soon as they have been received from our insurers Keyman Term Life Optional TPD Trauma Income Protection Personal details Your Name Gender Male Female Date of birth Do you smoke Yes No Occupation Duties Work You Do Responsibilities Any recent Health problems In addition to keyman term life optional covers are also available Keyman Term Life protection Sum insured Optional Total Permanent Disablement Sum insured Optional Trauma Recovery protection Sum insured If you are also seeking income protection Monthly gross salary before tax per month Monthly cover maximum 75 of salary per month Waiting period requested days 14 30 Recommended 90 Excess Cover period

    Original URL path: http://www.brokersnational.com.au/KEYMAN.htm (2013-02-03)
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  • Group Travel
    and then Fax It to our office on 03 9791 6633 Use the Mouse or the Tab key to move to the next field We will respond with quotes as soon as they have been received from our insurers We offer two types of travel insurance personal for singles and families and corporate Please fill in the appropriate form for the cover you wish to be quoted on Personal Travel Insurance for singles or families OR Corporate Group Travel Insurance Personal Travel Insurance Personal details What type of cover do you require Single Family Your Date of Birth DD MM YYYY Date of Birth for other people to be insured Person 2 Person 3 Person 4 Travel Details Departure Date DD MM YYYY Return Date Period of Journey days months Major Destination Worldwide Europe Asia Middle East Pacific Islands America Canada Africa Within Australia Any other comments requests or relevant information you need to add Contacting you about your quote Please make sure you leave a contact phone number and the best time to call you Your Name Company Name Your Phone Number Area Code Best Time s To Call Please send my quote by select at least one email phone fax mail Your Email Your Facsimile Your Postal Address Click On Email Quote To Send Form To Us Corporate Travel Insurance Company details Description of Plan Required All Business Trips Involving Air Travel Overseas Business Trips Only Interstate Business Trips Business Trips Plus Directors Private Travel Please Describe Reasons For Business Travel Normal Overseas Destinations Positions of persons to be insured Any Non Scheduled Aircraft Please provide details Description of Travel Overseas Inter Intrastate Number of Trips Average Duration Of Each Trip days days Description of Benefits Sum Insured A Capital Lump Sum Death Disablement Weekly Injury Benefit per

    Original URL path: http://www.brokersnational.com.au/GROUP_TRAVEL.htm (2013-02-03)
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  • Superannuation
    arrangement possible We may receive a fee for referring business to our associates Please fill in the following form answering all questions then either 1 Click on Email to Brokers National at the bottom of this form OR 2 Highlight this form to Print It and then Fax It to our office on 03 9791 6633 Use the Mouse or the Tab key to move to the next field Superannuation

    Original URL path: http://www.brokersnational.com.au/SUPERANNUATION.htm (2013-02-03)
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  • Body Corporates
    improvements e g water fuel tanks silos bore pumps power lines etc Specified Items Including Electronic Equipment Item Description Sum Insured Is there any further details relating to Farm Property you wish to provide back to list 3 Tractors and Farm Machinery Year Make Model or Description Engine or Serial Number Sum Insured Any further details relating to Tractors and Farm Machinery you wish to provide back to list 4 Livestock Working Dogs Livestock Type of Animal Sum Insured Working Dogs Description Sum Insured Any further details relating to Livestock and Working Dogs you wish to provide back to list 5 Machinery Breakdown Please choose either Blanket Cover or Listed Machinery Cover a Blanket Cover Fill in the following table Dairies Vat capacity up to Sheep Stations Up to 10 000 head 5 000 litres Cattle Up to 1 000 head 10 000 litres Pastoralists 15 000 litres Piggeries 35 000 litres Poultry Layers b Selected Machinery Cover Specified Items Machinery Cover and Pressure Vessels when Blanket cover not taken Description Sum Insured Deterioration of Refrigerated Goods Sum Insured Any further details relating to Machinery Breakdown you wish to provide back to list 6 Farm Public Liability Liability Limit of Indemnity Number of working proprietors Number of employees Is your property used or leased for any purpose other than primary production e g sand and gravel pits or any other non farming activity If yes state details of activity Do you derive any income from contract farming If yes what percentage of your business income is involved State details if yes Any further details relating to Farm Liability you wish to provide back to list 7 Business Interruption Agistment Income Farming Continuation Expenses Any further details relating to Business Interruption you wish to provide back to list 8 Personal Accident and Illness First Person Second Person Surname First Second Name Date of Birth DD MM YYYY Height Weight cm kg cm kg Cover Required Accident and Illness or Accident Only Accident and Illness or Accident Only Benefits required Capital Sum Weekly Sum Capital Sum Weekly Sum For the following questions if you answer yes to any question Insurance or Medical please give details including description of injury or illness duration dates the cause nature of treatment and results current condition name and addresses of doctors and hospitals consulted First Person Second Person 1 Has this person ever been insured against injury or illness Yes No Yes No 2 Do you engage in any hazardous pursuits or pastime including motor sports rock climbing water skiing snow skiing horse riding Yes No Yes No 3 Is this person engaged in work other than farming with you or elsewhere Yes No Yes No 4 Have special terms ever been imposed for life or disability insurance or has any person ever been declined Yes No Yes No 5 Has this person received medical advice consulted a doctor undergone any medical treatment or investigations for high blood pressure or cholesterol any heart complaint or problem

    Original URL path: http://www.brokersnational.com.au/FARM_RURAL.htm (2013-02-03)
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  • Financial Planning
    We aim to find you the best financial planning arrangement possible We may receive a fee for referral to our associates Please fill in the following form answering all questions then either 1 Click on Email to Brokers National at the bottom of this form OR 2 Highlight this form to Print It and then Fax It to our office on 03 9791 6633 Use the Mouse or the Tab

    Original URL path: http://www.brokersnational.com.au/FINANCIAL_PLANNING.htm (2013-02-03)
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