Completing this online Proposal Form

Please answer all questions giving full and complete answers.
It is the duty of the proposer to provide all information that is requested in this Proposal Form as well as to disclose relevant facts. A relevant fact is a known fact or circumstances that may influence the evaluation of risk by the insurer. If you are uncertain about what a relevant fact is, please contact us.
If renewing an existing policy with Fenton Green, please ensure you check all information and make any necessary changes.

Business Details

Income Details

Total Annual Income

Staff Numbers

Please indicate total staff numbers including principals, partners and/or directors.

Do you perform any other activities other than

(a)  Registered Migration Agent Services in respect of immigration assistance performed pursuant to section 276 of the Migration Act 1958 (as amended);
(b)  Migration Education and Training Services;
(c)  Employment skill assessment and matching application services;
(d)  Education services by Affiliate Members of the MIA;
(e)  Translation and interpretation services by NAATI accredited translators and interpreters;
(f)  General referral services;
(g)  Risk assessment & compliance audit services; and
(h)  The preparation and submission of an application for Australian citizenship pursuant to the provisions of the Australian citizenship Act 2007 (cth)

Yes No

Describe the Other activities you perform:

Please provide an approximate % breakdown of Annual Income by State or Territory according to where it is earned:

Total must be 100%:

NSW

ACT

QLD

VIC

TAS

Overseas

Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?

Yes No

Association

Are you a member of the Migration Institute of Australia (MIA)?

Yes No

Period of Insurance

Policy Start Date