About this form

The information you provide in this Application Form will help Kobe assess your insurance needs. It will also be shared with underwriters to help source the best cover for you.  Please complete this openly and honestly because you do have a Duty of Disclosure.

Duty of Disclosure

Before submitting this application,  we have to tell you about your duty of disclosure at law which applies until an insurer agrees to insure you.

We will ask you questions that are relevant to our decision to insure you and on what terms. When answering our questions, you must tell us anything that you know and that a reasonable person in the circumstances would include in their answer. If you do not tell us anything you are required to, we may cancel your policy or reduce your claim, or both. If your failure is fraudulent, we may refuse to pay your claim and avoid the policy altogether. 

Privacy Policy 

By submitting this form, the personal information you provide to Kobe Insurance Pty Ltd in this form or otherwise may be collected, held, used and disclosed in the manner set out in the Kobe Insurance Services Privacy Policy, including for the processing of this application and providing cover.

Client Details

Details of the Business

Period of Insurance Start Date

(12 months cover)

Limit of Indemnity Required

General Information

In the last 5 years, have you:
Have you or your Partners or Directors:

Insurance Details

As a minimum, we need your current insurance details (renewal schedule or quote) to get started.  Please upload this below this and any other relevant files below

Appraisal Details

What is the the key reason for you getting an insurance appraisal?

Terms & Conditions

This appraisal does not constitute formal financial advice.  It does not take into account the objectives, financial situation or needs of any person.  Before making a decision on your insurance, you should consider whether it is appropriate in light of your particular objectives, financial situation or needs.  Your needs are considered as part of the quotation process that follows an appraisal.

Sydney Office

MKW Insurance Brokers

11 Thornleigh Avenue,
Concord, NSW, 2137

Postal Address:

MKW Insurance Brokers
P.O. Box 166,
Concord, NSW, 2137

Phone: (02) 9746 6273
Fax: (02) 9746 6255
Email: insurance@mkwib.com.au

Central Coast Office

MKW Insurance Brokers

38 Manns Road,
Narara, NSW, 2250

Phone: (02) 4311 6175

Email: centralcoast@mkwib.com.au

West Pymble Office

MKW Insurance Brokers

79 Lofberg Road,
West Pymble, NSW, 2073

Phone: 0438 637 843

Email: insurance@mkwib.com.au

MKW Holdings Pty Ltd T/as MKW Insurance Brokers
ABN 53 617 495 495

AFSL 502391