Life Sciences | Proposal Form

R&D Tax Incentive Costs & Expenses

How would you like to submit your proposal?

Choose one submission method. You can complete the proposal online, or upload the completed and signed Avatar PDF proposal.

Select1Complete the online proposalEnter the company details, answer the proposal questions and sign electronically on this page.

Select2Upload a completed PDF proposalUpload the completed and signed proposal. It will be checked before it is accepted.

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Important information

›Duty of Disclosure

Before you enter into a contract of general insurance with an insurer, you have a duty, under the Insurance Contracts Act 1984 (Cth), to disclose to the insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer's decision whether to accept the risk and, if so, on what terms. You have the same duty before you renew, extend, vary or reinstate a contract of general insurance.

Your duty, however, does not require disclosure of a matter that:

Diminishes the risk.
Is common knowledge.
Is known, or ought reasonably be known, by the insurer in the ordinary course of business.
Is a matter for which compliance with the duty of disclosure has been waived by the insurer.

›Non-disclosure

If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce its liability in respect of a claim or cancel the contract. If the non-disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning.

›Claims Made Insurance

This means that the policy covers you for any claims made against you and notified to the insurer during the policy period or any applicable reporting period.

The policy does not provide cover in relation to:

Any claim made, threatened or intimated against you prior to the commencement of the policy period.
Any claim or fact that might give rise to a claim, reported or which can be reported to an insurer under any insurance policy entered into before the commencement of the policy period.
Any claim or fact that might give rise to a claim, noted in this proposal or any previous proposal.
Any claim arising out of any fact you are aware of before the commencement of the policy period.
Any claim made against you after the expiry of the policy period.

However, the effect of Section 40(3) of the Insurance Contracts Act 1984 (Cth) is that where you become aware, and notify us in writing as soon as is reasonably practicable after first becoming aware but within the policy period, of any facts which might give rise to a claim against you, any claim which does arise out of such facts shall be deemed to have been made during the policy period, notwithstanding that the claim was made against you after the expiry of the policy period.

Completion guidance

Please complete all applicable sections. If there is insufficient space to answer a question, include further details under Additional Information.

Company details

Name of company *

ABN / ACN / Business Registration No *

Occupation / business activities *

Annual turnover (AUD) *

Date established *

Street address *

Post code *

City *

Contact name *

Position *

Telephone *

Email *

Website address

Accounting firm

Accounting firm name *

Accountant / primary contact *

Claim history

In the past five years, to the best of your knowledge, has the Principal Company or any Subsidiary experienced any of the following?

Claim details

Additional information

Additional comments / disclosures

Limit required

Please select the limit(s) of indemnity you would like us to obtain terms for. Multiple selections may be made. *

SelectA$100,000 any one claim / $250,000 in the aggregate

SelectB$250,000 any one claim / $500,000 in the aggregate

SelectC$500,000 any one claim / $1,000,000 in the aggregate

Please select at least one limit option.

Declaration and electronic signature

This declaration must be completed by a person authorised to sign on behalf of the proposer.

Signatory name *

Title / position *

Date *

Type full legal name *

Draw electronic signature *

Use a mouse, finger or stylus

I am authorised to complete and sign this proposal on behalf of the proposer. I declare that the answers and statements provided are true, complete and correct, and I understand that this electronic signature records my intention to sign this proposal. *I acknowledge that the information supplied may be provided to insurers and other parties involved in arranging and administering the insurance. *

Thank you, your proposal has been submitted.
We will be in contact within 1-2 business days.