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Insurance advisers for:

  • Licensed brothels
  • Escort agencies
  • Massage parlours
  • Adult clubs
  • Adult shops
  • Nightclubs

For an obligation-free insurance quote, please answer all the following questions and submit your request:

 

ONLINE QUOTE FORM:
Is this enquiry from a broker on behalf of a client? Yes No
Is this enquiry for a:
Is this enquiry for:
Please select the insurance cover required: Property (Fire and other specified perils)
Business Interruption
Theft
Money
Glass
Liability
What is the required start date for the insurance?
   
Contact Details:
Name:
Postal Address:
(for all correspondence)
State:
Postcode:
   
Business Details:
Insured/Business Name:
Trading Name (if applicable):
ABN Number:
   
Have you or any partner/director/or manager of the business:
Made any claims in the last 5 years for loss or damage? Yes No
Had any insurance declined or cancelled? Yes No
Had a loss that would have been covered by the cover now sought? Yes No
Ever been bankrupt or insolvent? Yes No
Ever been convicted of any criminal offences? Yes No
If you have answered “Yes” to any of the above questions please give details:
   
Details of the Business and/or Premises:
Type of Business:
No. of Years: In this business:
At this location:
Address of the Property to be Insured:
Town:
State:
Postcode:
Current Insurer (and Broker if applicable):
Construction of Walls:
Construction of Floor:
Construction of Roof:
Number of Storeys:
Age of Building:
   
How are the premises protected?
Fire Sprinkler System:
 Yes No
Automatic Fire Alarm: Yes No
Fire Hoses:
 Yes No
Fire Extinguishers:
 Yes No
Deadlocks on all external doors:
 Yes No
Bars/grills and/or keyed locks on all external windows: Yes No
Burglar Alarm System:
 Yes No
If you have an alarm, which type?
   
Additional/Other Comments
PRIVACY STATEMENT:
Adult Industry Business Insurance (aibi) is the trading name of Raylorden Insurance Brokers Pty Ltd which is bound by the obligations of the Privacy Act. This Act sets basic standards relating to the collection, use, disclosure and handling of personal information. The information you provide will be solely used for the quotation and administration of the appropriate insurance cover. You can choose at any time not to disclose some information to us, but this may hinder the service we provide. Part of the information collected may be regarded as “sensitive” and will not be collected without your consent. You may gain access to the personal information we hold about you by contacting the Privacy Officer. By submitting this form you hereby declare that you have read this privacy statement and consent to the collection of the above information by our company. For full details please read our Privacy Policy which is attached.
   
Name:
Position:
Date:
 
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