Electrical Contractors Insurance Declaration

Page 1 of 7 - Details

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Are you currently insured with MGA Insurance Group?

Are you currently insured with MGA Insurance Group? Yes, I am renewing an existing policy with MGA No, I would like a new quote
Please enter the desired start date you'd like to be covered from? Please enter the desired start date you'd like to be covered from? / DD / MM YYYY
INSURED DETAILS
Applicants first name
Applicants last name
ABN Lookup

The link HERE will take you to the Australian Business Register's ABN Lookup website.
Full Company Name
Trading Name
ABN
Do you use more than one trading name?

Do you use more than one trading name? Yes No
Additional trading name/s
Are you incorporated (Pty Ltd)?

Are you incorporated (Pty Ltd)? Yes No

An incorporated business is a separate entity from the business owner and registered as a proprietary company limited by shares. An unincorporated business is typically a sole proprietor or partnership company. A business owner is protected from liabilities they might incur from running the business whilst an unincorporated business is not.
Business address

Business Address must be a physical street address.
Suburb
State
Postcode
Country
Primary phone number
Secondary phone number
Email Address
Fax
Is the postal address same as business address?

Is the postal address same as business address? Yes No
Postal Address

Business Address must be a physical street address.
Suburb
State
Postcode
Country
Do you have any subsidiaries, trusts & trustees you would like to be covered by the public liability policy?

Do you have any subsidiaries, trusts & trustees you would like to be covered by the public liability policy? Yes No Don't know

Subsidiary

A subsidiary is a company whose voting stock is more than 50% controlled by another company, usually referred to as the parent company or holding company. A subsidiary is a company that is partly or completely owned by another company that holds a controlling interest in the subsidiary company.
Please provide further information
Do you require an interested party noted on the certificate of insurance?

Do you require an interested party noted on the certificate of insurance? Yes No

A person or entity who is not a party to the insurance contract but has a right of recovery under the policy. A financer may require their interest to be noted on a property damage or motor vehicle policy. A commercial contract or lease may require the principal or lessor to be noted as an interested party in respect to a public liability policy. A person or entity who has their interests noted on the policy is not entitled to claim under that policy and serves as a notice to the insurer that someone else has an insurable interest.
Please specify
Business Description
Are you a current NECA Association Member?

Are you a current NECA Association Member? Yes No
Please provide NECA Membership Number
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Electrical Contractors Insurance Declaration

Electrical Contractors Insurance Declaration

Page 1 of 7 - Details

INSURED DETAILS

ABN Lookup