Make a Change to a Business Risk Policy

If you want to change your payment method, you can set up a new direct debit here.

Let us know how we can help by selecting one of the options from the list below and submitting the form on this page.

For assistance with anything else not listed here, please call 0800 800 627.

Please note, this form is not processed immediately upon submission, and amendments to your policy are not covered until we have reviewed and accepted your request. If you need to urgently amend your policy, please call 0800 800 627.

How can we help?

I want to increase/decrease my sum insured
I want to add additional cover/s and/or cover extension/s
I want to change or add a situation of risk
I want to cancel my policy
Other

What change would you like to make?

For a change to a situation of risk, or for an additional risk, please complete the Site Survey below.

Title:

Miss
Ms
Mrs
Mr
Doctor

First Name:

Surname:

Member Number:

Phone:

Email Address:

Address:

Date you want this change in policy to take effect:

What is the reason for cancelling your policy?

I have sold the business
I have moved to another insurer
Other

Settlement date:

Why have you chosen to move to another insurer?

Which insurer have you moved to?

Please provide details:

Do you want to increase or decrease your sum insured?

Increase
Decrease

Why do you want to increase your sum insured?

Why do you want to decrease your sum insured?

What would you like your new sum insured amount to be?

If your new sum insured is over $1,000,000, an insurance valuation less than two years old is required. Please provide a copy of your insurance valuation here.

Maximum 5 files (JPG, PNG or PDF); up to 20 MB per file.

What cover would you like to add to your policy or extend?

Please tick all cover options you require.

Portable Contents
Refrigerated Stock
Records and Data
Public Liability/Statutory Liability/Employers Liability
Employee Dishonesty
Employment Disputes

Portable Contents cover

Do you want to add Portable Contents as a new cover, or add a cover extension?

Add a new cover
Add a cover extension

What is the nature of the portable contents?

What is the maximum value of goods taken away from the risk location at any one time?

What is the likely value of the single most valuable item taken away at any one time?

How are portable items stored when not in use?

For example, kept in vehicle or removed to be stored at home or business premises.

If portable items are stored in a vehicle, how is the vehicle secured overnight?

For example, parked in the street, driveway, garage.

Refrigerated Stock cover

Do you want to add Refrigerated Stock as a new cover, or add a cover extension?

Add a new cover
Add a cover extension

What is the nature of the refrigerated stock?

What is the maximum amount held at any one time?

Is your refrigerator designed for keeping medicine/vaccines?

How old is your refrigerator?

Less than three years old
Less than ten years old and serviced at least annually

Is your refrigerator protected by an appropriate surge protection device?

What is your backup plan for keeping stock within acceptable temperature limits in the event of a refrigerator failure?

Does your refrigerator have a proactive monitoring device which sends you an alert before the temperature falls outside of acceptable bounds?

Please provide details of the monitoring device

Please include a website link if possible

Records and Data cover

Do you want to add Records and Data as a new cover, or add a cover extension?

Add a new cover
Add a cover extension

What steps are taken to back up records and data?

What steps have been taken to prevent power fluctuations from damaging your records?

Public Liability/Statutory Liability/Employers Liability cover

Please complete the following details in respect of the insured entity.

Do you want to add Public Liability/Statutory Liability/Employers Liability as a new cover, or add a cover extension?

Add a new cover
Add a cover extension

What is the annual revenue amount?

How many FTE vocationally registered practitioners are employed?

How many FTE support staff are employed?

Employee Dishonesty cover

Please complete the following details in respect of the insured entity.

Do you want to add Employee Dishonesty as a new cover, or add a cover extension?

Add a new cover
Add a cover extension

What is your annual revenue?

What is the number of FTE vocationally registered practitioners employed?

What is the number of FTE support staff employed?

In the past three years has any staff member stolen cash/goods from you?

Please provide details of the incident, any police involvement, and the outcome of each incident.

Employment Disputes cover

Do you want to add Employment Disputes as a new cover, or add a cover extension?

Add a new cover
Add a cover extension

Do you have a formal staff recruitment process?

Please outline what steps and processes you follow in the recruitment and selection of staff, including the taking and retention of records

Do you have a formal staff performance and appraisal process?

Please outline how you monitor and review the performance of your employees.

Do your employees have a position description?

Do your employees have agreed goals and objectives?

Do your employees have written appraisals, at least annually?

What is the name and position of the person in your organisation responsible for ensuring the business complies with employment related legislation?

What is the name and position of the person in your organisation responsible for the preparation of employment-related documents, including employment agreements, personal files, and payroll records??

Do each of your staff members have a written employment agreement?

Are you a member of any organisation providing employment advice, subscribe to the Employers and Manufacturers Association or the services provided by MAS through our Business Advisory Services?

Please provide the name of the organisation/s and their services provided to you.

Who are your advisors on matters relating to human resource management issues?

Are you aware of any current issues that may give rise to a dispute or personal grievance?

Please provide further details on this dispute or personal grievance

Please advise what amendments you would like to make to your policy, if the option is not listed on this form.

Site Survey Questionnaire

What change is being made to the business situation of risk?

Change to existing policy
Policy renewal
Change or additional risk site

Please describe the situation of risk

How many stories is the building?

What year was the building built?

What category would the building fit into?

Pre 1935
1935-1965
1965-1971
1972 onwards
Under construction

What is the buildings NBS Rating?

0-20%
20-33%
33-66%
67-100%
100%+
Unknown

Has the building been earthquake strengthened?

Do you require cover for the fit-out of the building?

Please provide the amount required for the fit-out

Do you own the building or are you a tenant?

Owner
Tenant

Are there other tenants in the building?

Please provide details of the other tenants in the building

Does the building have any domestic portion that qualifies as a 'Dwelling' under the ECQ Act?

Please provide the number of units

What is the building constructed of?

Timber/Steel Frame
Masonry/Brick
Mixed

Does the building contain any insulated panel construction?

What % of the building contains insulated panel construction?

What parts of the building contain insulated panel construction?

What fire protection does the building have?

Monitored fire alarm
Unmonitored fire alarm
Smoke alarm/Detectors
Sprinkler system
Fire extinguishers
Fire hose reels
None
Other

What other fire protection does the building have?

What security protection does the building have?

Monitored security alarm
Unmonitored security alarm
CCTV
None
Other

What other security protection does the building have?

Is the building subject to a warrant of fitness?

Is the building warrant of fitness current?

Please describe the general condition of the building, including any maintenance that is required

Disclosure of relevant information

I understand that I have a duty to disclose all information that Medical Insurance Society Limited (MAS) may want to take into account in deciding whether or not to accept my application and if so, what terms. I confirm that:

all answers in this application are true and correct and complete.
I have disclosed everything I know that may be relevant to this insurance.

I understand that if I have not disclosed all relevant information that I know, MAS may decline a claim I make under this policy, cancel the policy or treat the insurance as being invalid from the beginning.

Medical Insurance Society Limited has a Financial Strength Rating of A from approved rating agency S&P Global Ratings Australia Pty Ltd and this reflects our ability to pay claims.

Privacy Act 2020

I understand that:

the personal information MAS collects from me will be used to underwrite and administer my insurance.
I am entitled to access and correct the personal information MAS holds out about me, in accordance with the provisions of the Privacy Act 2020.

I authorise MAS to give or obtain personal information about me (relevant to my insurance) to or from others including but not limited to the Insurance Claims Register Limited.

Please tick this box to confirm you've read and understood the declaration above

By completing this form you authorise MAS to collect and use your personal information to contact you about MAS products and services. By providing your email address, you consent to receive emails from us from time to time about our products and services. Any emails we send will contain an option for you to unsubscribe so you can opt-out at any time.

Medical Insurance Society Limited has an A- rating with a positive outlook from approved rating agency Standard & Poor’s, and this reflects our ability to pay claims.