Faith Insurance

Type of Organisation

Please provide an approximate % breakdown of Annual Income by State or Territory according to where it is earned:

NSW

ACT

QLD

VIC

TAS

Overseas

Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?

Yes No

Do you require Building and/or Contents Insurance?

Location 1

Do you Own the Premises?

Yes No

Do you occupy the building?

Yes No

Is the property Heritage Listed?

Yes No

Street Number/Name:

Suburb:

Postcode:

State:

Contents Replacement Value:

Location 2

Do you Own the Premises?

Yes No

Do you occupy the building?

Yes No

Is the property Heritage Listed?

Yes No

Street Number/Name:

Suburb:

Postcode:

State:

Contents Replacement Value:

Location 3

Do you Own the Premises?

Yes No

Do you occupy the building?

Yes No

Is the property Heritage Listed?

Yes No

Street Number/Name:

Suburb:

Postcode:

State:

Contents Replacement Value:

Location 4

Do you Own the Premises?

Yes No

Do you occupy the building?

Yes No

Is the property Heritage Listed?

Yes No

Street Number/Name:

Suburb:

Postcode:

State:

Contents Replacement Value:

Location 5

Do you Own the Premises?

Yes No

Do you occupy the building?

Yes No

Is the property Heritage Listed?

Yes No

Street Number/Name:

Suburb:

Postcode:

State:

Contents Replacement Value:

Promotional Code (if relevant)

Organisation Information