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crib
ABN 52 074 444 296
- Member of National Insurance Brokers Association and Steadfast Group Limited -
- Australian Financial Services Licence No. 237491 - General Insurance Broker -
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227-229 Hutt Street, Adelaide South Australia 5000 - PO Box 7138 Hutt Street, Adelaide South Australia 5000
Ph: (08) 8100 0800  Interstate Enq: 1300 887 429  Email: info@crib.com.au  Web: www.cityrural.net.au  Fax: (08) 8100 0089
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Questionnaire

     
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EVENT / ENTERTAINMENT INSURANCE PROPOSAL

BROADFORM LIABILITY INSURANCE

Event or Entertainment Liability insurance is available for the smaller family gathering through to major events (Market Organizers should complete our Market Organizers Liability application form). This policy will provide protection to you, where you have a liability at law for property damage &/or bodily injury to another person.

In order for City Rural Insurance Brokers to provide you with an Obligation Free Quote, please complete the following.

Fields designated in RED are required to be completed
Proposal Details
Name of person, company or entity seeking insurance
Phone
 Fax
Email
Location
 Postcode
Postal Address
(same as above or)
 Postcode

Preferred Method of Contact
Phone  Fax  Post Email
Period of Insurance
From (date)  
4pm
To (date)  
4pm
Limit of Indemnity Required (Public and Products Liability)
 $10,000,000   $20,000,000
Please describe nature of organization,event
Description of activities undertaken
If business is musician, please state style of music played: Rock/Funk/Jazz/Orchestral/Country/Blues/Other
Description of venue(s) where meetings/performances are held
Number of meetings/performances per annum
Estimated Number of Attendees
Per Performance
All Performances
Number of members, if applicable
Do you engage Sub-Contractors and/or Service Providers? Yes No
If Yes, please provide full details
Number of Tutors/Entertainers
 Number of Other Staff

Turnover for last 12 months
 Estimated Turnover for the coming twelve months
Are there any hazardous activities associated with your business? Yes No
If Yes, please provide full details
Construction of the premises
Walls
 Floors
 Roof
 No. of Storeys
Age of Building
Please provide details of Fire Protection and Security
Contractual Liability
Coverage for Liability assumed under agreement or contract will be limited to lease liability or liability assumed under a warranty of fitness or quality as regards your products.
Do you assume Liability under contract or hold others harmless (other than lease liability)? Yes No
If yes, please provide details and attach copies of all agreements (other than lease liability).
General Information
Are you or have you previously been insured against the risks to be insured? Yes No
If Yes, please provide full details
Have you had any claims made against you (whether insured or not)? Yes No
If Yes, please provide full details
Have you had any incident or accident occur which would have been covered by the proposed insurance policy? Yes No
If Yes, please provide full details
Have you had any insurance declined or cancelled, proposal rejected, renewal refused, claim rejected, special conditions or special excess imposed by an insurer? Yes No
If Yes, please provide full details
Have you ever been convicted of a criminal offence? Yes No
If Yes, please provide full details
Is there anything more you need to disclose to us? Yes No
If Yes, please state what it is that you think we ought to know.
Your Duty of Disclosure and Utmost Good Faith
I have read the Duty of Disclosure (view)
Duty of Disclosure

In order to make an informed assessment of the risk and calculate the appropriate premium, your insurer needs information about the risk you are asking it to insure.

For this reason, before you enter into a contract of insurance, you have a duty under the Insurance Contracts Act 1984 to disclose to your 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. The duty also applies when you renew, extend, vary or reinstate a contract of insurance.

You do not have to disclose anything that:

  • Reduces the risk to be undertaken by the insurer;
  • Is common knowledge;
  • Your insurer knows, or in the ordinary course of its business, ought to know; or
  • If the insurer has waived your obligation to disclose.
If you do not comply with your duty of disclosure, your insurer may be entitled to reduce its liability in respect of a claim or may cancel your contract of insurance. If the non-disclosure was fraudulent, the insurer may be able to avoid (or cancel) the contract of insurance from its beginning. This would have the effect that you were never insured.

One important matter to be disclosed is the history of losses suffered by the person seeking insurance or any closely associated person or entity. As you are responsible for checking that you have made complete disclosure, we suggest that you keep an up to date record of all such losses and claims.