Company Insurance Details

Company Name *

Name of person completing this form *

Name of the Whizdom representative you are working with *

Do you hold PI/PL insurance? *

YesNo

Public Liability - Level of Coverage *What is your Public Liability Insurance amount on a single occurrence basis?

Public Liability Insurance expiry date *

Professional Indemnity - Level of Coverage *What is your Public Liability Insurance amount on a single occurrence basis?

Professional Indemnity expiry date *

Please upload your current PI/PL Insurance Certificate

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Do you hold WC Insurance *

YesNo

Please select each State/Territory you hold WC Insurance *

ACTNSWQLDVICSAWANTTAS

ACT WC expiry date *

Upload your ACT WC insurance certificate *

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NSW WC expiry date *

Upload your NSW WC insurance certificate *

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QLD WC expiry date *

Upload your QLD WC insurance certificate *

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VIC WC expiry date *

Upload your VIC WC insurance certificate *

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SA WC expiry date *

Upload your SA WC insurance certificate *

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WA WC expiry date *

Upload your WA WC insurance certificate *

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NT WC expiry date *

Upload your NT WC insurance certificate *

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TAS WC expiry date *

Upload your TAS WC insurance certificate *

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