Entertainment and Events Proposal Form

Insurance Category:
CONTACT INFORMATION
First Name:*
Surname:*
E-mail:*
H2 News: Stay Connected. Stay Protected.

Connect Me
Primary Phone Number:*
Please enter 10 digits with no spaces.
Secondary Phone Number:
Please enter 10 digits with no spaces.
Address:*

Street Address

City

SuburbState

PostcodeCountry
Alternative Postal Address:

Yes
Postal Address:*

PO Box/ Street Address

City

SuburbState

PostcodeCountry
INSURED
Insured Name:*
Business Structure:*

Sole TraderPartnershipCompany
Do you have an ABN?*
ABN:*
11 digits/ no spaces.
Are you GST registered?*
I/ We agree the Privacy Policy Statement is acceptable:*

Yes to continue

Your 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 of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the insurer before you renew, extend, vary or reinstate a contract of general insurance.

Your duty however does not require disclosure of matter:
- that diminishes the risk to be undertaken by the insurer;
- that is of common knowledge;
- that your insurer knows or, in the ordinary course of its business, ought to know;
- as to which compliance with your duty is waived by the insurer.
Non-Disclosure
If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce their liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning.

Statutory Liability Extension and Errors & Omission Endorsement is Claims Made Insurance
The Statutory Liability and Errors & Omission is an Extension to the Policy and is ‘Claims Made’ insurance. This means that the extension covers you for any claims made against you and notified to the insurer during the period of insurance.

This extension does not provide cover in relation to:
- acts, errors or omissions that occurred prior to the retroactive date (if one is specified) in the policy;
- any claim made, threatened or intimated against you prior to the commencement of the period of insurance;
- 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 period of insurance;
- 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 period of insurance;
- any claim made against you after the expiry of the period of insurance.
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 period of insurance, 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 period of insurance, notwithstanding that the claim was made against you after the expiry of the period of insurance.

Your Duty of Disclosure requires you to tell us of any information that may affect our/an insurers decision to insure you. Each person(s) or entity named as the insured has this duty of disclosure. If you do not tell us about any information which may be relevant to accepting this insurance, this may result in the refusal or redirection of claims or the cancellation of this policy.

I/We have read and agree to the above and by completing the following fields, declare that the information provided above and in all appending sections is true to the best of My/Our knowledge.
I/ We have read, understood and accept these conditions:*

Yes to continue

TURNOVER
Estimated Annual Turnover for the Forthcoming Period:*
Estimated Wages for the Forthcoming Period:*
Details of Employees Activities:*
Do you use Volunteers?*
Details of Volunteer Activities:*
More Details:

Upload a File

Cancelof
Do you engage Subcontractors?*
Estimated Subcontractor Payments for the Forthcoming Period:*
Details of Subcontractor Activities:*
More Details:

Upload a File

Cancelof
Do you ensure that all Subcontractors, contractors and all other service providers supply proof of:
(If you are not sure about the difference in definition of subcontractors, contractors of employees, please feel free to use this link to resources of government definitions)
THEIR OWN Public Liability Insurance:*
Documented Evidence (Certificate of Currency)*
Do you use Labour hire?*
Estimated Labour hire Payments for the Forthcoming Period:*
Details of Labour hire Activities:*
More Details:

Upload a File

Cancelof
Will there be a contracted 3rd party providing Fireworks with their own insurance?*
One of our brokers will be in contact to discuss this further.
More Details:

Upload a File

Cancelof

AMOUNT OF INDEMNITY REQUIRED
Amount Required:*
STATUTORY LIABILITY COVER - OPTIONAL EXTENSON
There are over 5000 legislative provisions in Australia that cater for civil penalties, and fines for Occupational health and Safety breaches that can be as high as $550, 000. Statutory Liability cover is a cost effective extension of this policy that helps to protect you against these fines and penalties. It also provides for legal assistance in defending civil fine actions.
Is a Statutory Liability cover quote required?*
Have you had any fines or penalties in the last five years?*
Date of Fine:*
Amount:*
Offence:*
Add Additional Fines:

Yes
Date of Fine:*
Amount:*
Offence:*
Add Additional Fines:

Yes
Date of Fine:*
Amount:*
Offence:*

DECLARATION
You declare to the best of your knowledge and belief and having diligently made all necessary inquiries the information provided in connection with this proposal, whether in your own hand or not, is true and you have not withheld any material facts. If you fail to comply with your duty of disclosure, we may be entitled to reduce our liability in respect of any claim you make or we may be entitled to cancel the policy. If your non-disclosure is fraudulent, we may also have the option of avoiding the contract from its beginning, meaning that the policy would no longer be valid and we would have no liability to pay any claim.

NOTE: * A material fact is one likely to influence acceptance or assessment of this Proposal and the attached Appendices by us: if you are in any doubt as to what constitutes a material fact you should consult your Broker. It is understood that the signing of this Proposal does not bind you to complete or us to accept this Insurance, but you agree that, should a contract of insurance be concluded, this Proposal, Appendices and any supporting information shall be incorporated into and form the basis of the contract.
Full Name:*

First NameLast Name
Signature:*
Title/ Position:*
Date:*
I/ We have read, understood this information and wish to apply:*

Yes to continue
Please enter the message as it's shown:*

Should be Empty:

CONTACT INFORMATION

INSURED

DUTY OF DISCLOSURE QUESTIONS

TURNOVER

BUSINESS DESCRIPTION

ANNUAL/ MULTIPLE EVENT LIABILITY

PERFORMERS LIABILITY

FILM LIABILITY

FIREWORKS

SOUND AND LIGHTING LIABILITY

SPECIFIC EVENT LIABILITY

RISK MANAGEMENT

CLAIMS AND/OR LOSS EXPERIENCE

AMOUNT OF INDEMNITY REQUIRED

STATUTORY LIABILITY COVER - OPTIONAL EXTENSON

DECLARATION