ASBESTOS ADDENDUM

Name of Insured:

1.	For all contractors/subcontractors, do you always confirm they hold a current policy for:

Liability insurance?	Choose an item.

Asbestos Liability insurance?	Choose an item.

If so, what is the Limit of Indemnity?	$

3. Are you always named as Principal on a contractor’s/subcontractors insurance policy for Asbestos Liability Insurance	Choose an item.

4.Please state your estimated gross annual turnover/income for each activity below:
Gross Annual Turnover/Income	Value sub contracted out
Demolition – with asbestos removal
Strip-outs – with asbestos removal
Asbestos Removal – excl demolition & strip outs
Waste/landfill operation with asbestos
Asbestos Sampling/Testing
Working With &/or Making Safe Asbestos
Any other Asbestos related operation
Asbestos carting and disposal
Asbestos carting only

5.Turnover dissection for Stamp duty calculations

Percentage of 1(a)vi for current year in each state or territory.

ACT	NSW	NT	QLD	SA	TAS	VIC	WA	Overseas
%	%	%	%	%	%	%	%	%

4..	(a)	Please state the 5 largest contracts which have commenced during the past 3 years where asbestos activities etc. have been involved:

Contract Period	Type of Contract (Demolition, strip out etc.)	Total Contract Value Aust $ Mill	Value subcontracted	State if any Professional Services Provided
J	$

(b)	Please give details of the three largest new contracts which are likely to commence in the coming 12 months where asbestos activities etc.are to be involved

Contract Period	Type of Contract (Demolition, strip out etc.)	Total Contract Value Aust $ Mill	Value subcontracted	State if any Professional Services Provided
$	E

(c)	Does any contract or client represent more than 60% of annual work where asbestos activities etc are to be involved?	Choose an item.

If YES, please give details

5.	Are any of the Directors, Principals or employees, AFTER ENQUIRY, aware of any circumstances which may give rise to a claim against the Insured Company or any circumstances which may give rise to a claim against you for any asbestos related activities	Choose an item.

If YES, please give details

6.	Give particulars of any claim made by the Insured during the past five years in respect to any claims or circumstances both insured and uninsured involving any asbestos related activity,

Date	Cost before Excess	Excess	Details

Please attach additional schedule if there is insufficient space.

Confirmation of compliance of duty of disclosure by the insured

Name

Position

Date	Click here to enter a date.