Insurance - Cancellation of Events Policy Proposal

Insurance - Cancellation of Events Policy Proposal

[Your company name, ABN, address, phone number, fax number, website, email]



CANCELLATION OF EVENTS POLICY PROPOSAL

Important Notices

Please read the following before proceeding to complete this proposal form.

Completed proposals should not be forwarded to the below privacy contact details. Completed proposals should be forwarded to your insurance broker or [Your company name] at [Your company email address].

[Your company name, ABN, AFSL] acts as an agent on behalf of [Your insurance company, ABN, AFSL], the insurer of this product.

General Insurance Code of Practice

[Your insurance company] is a signatory to the General Insurance Code of Practice. The Code aims to raise standards of service between insurers and their customers.

For any information about the Code, including a copy of the Code, contact [Your insurance company] on [Your 1300 number] or visit [Your Code website].

Your Duty of Disclosure

This policy is subject to the Insurance Contracts Act 1984 (Cth). Under that Act you have a Duty of disclosure.

Before you take out insurance with us, you have a duty to tell us of everything that you know, or could reasonably be expected to know, that is relevant to our decision to insure you and to the terms of that insurance. If you are not sure whether something is relevant you should inform us anyway.

You have the same duty to inform us of those matters before you renew, extend, vary, or reinstate your contract of insurance.

Your duty however does not require disclosure of matters that:

  • ·       reduce the risk
  • ·       are common knowledge
  • ·       we know or, in the ordinary course of our business, ought to know, or
  • ·       we have indicated we do not want to know.

If you do not comply with your duty of disclosure, we may be entitled to:

  • ·       reduce our liability for any claim
  • ·       cancel the contract
  • ·       refuse to pay the claim
  • ·       avoid the contract from its beginning, if your nondisclosure was fraudulent.

Privacy Statement

Both [Your insurance company name and your company name] respect your privacy. Any personal information provided by you will be treated in accordance with the Privacy Act 1988 (Cth). This privacy notification provides a summary of how [Your insurance company name and your company name] treat your personal information.

[Your insurance company name and your company name] primarily collect your personal information via this form to assess your request for insurance and to administer your Policy but may also use this information to settle an insurance claim, provide other insurance services as requested by you, and also to notify you about other services or promotions from time to time.

If you do not provide the information requested you may breach your duty of disclosure, your application may not be capable of being accepted, additional conditions may be imposed on any cover provided or your Policy may not be able to be administered.

In order to provide its insurance services [Your insurance company name and your company name] may need to disclose your personal information to third parties including, but not limited to: agents, underwriters, advisors and brokers; claims management and other service providers; claims adjusters, loss assessors and other claims investigators; lawyers; reinsurers and reinsurance brokers; and the Financial Ombudsman Service, or as required by law (for a full list see [Your insurance company name and your company name] Policies). In the event of the claim, [Your insurance company name and your company name] may disclose your personal information (including sensitive information) to overseas reinsurers for the purpose of assessing your claim. [Your insurance company name and your company name] will only share information with third parties where [Your insurance company name and your company name] reasonably believe it is necessary in assessing your insurance claim and in providing the products and services requested.

[Your insurance company name and your company name] Privacy Policies contain information about how to access and correct the personal information about you and also how to complain about a breach of privacy. If you would like additional information about privacy or would like to obtain a copy of the Privacy Policies, please contact [Your insurance company’s] Privacy Officer by

·       Tel: xx xxxx xxxx

·       Fax: xx xxxx xxxx

·       Email: xxxx@xxxx.com

·       Mail: xxxxx etc.

You can download a copy of [Your insurance company’s] Privacy Policy by visiting [Your insurance companies Privacy Policy website link].

You can also download a copy of [Your company’s] Privacy Policy by visiting [Your company’s Privacy Policy website link]

 

Please answer questions fully, use capital letters and tick appropriate boxes

Your Details

Name:                                                                                                       

ABN:                                                                                                         

Address:                                                                                                                                                                                                                               Postcode:                        

Contact:                                                                                                    Position:                                                                    

Email:                                                                                                         

Telephone:                                                           Fax:                                                           

Website:                                                                                                                                 

The Event

Dates of Event (tenancy dates): From:                                                 To:                                             

Event Venue(s):                                                                                                                                       

Name of Event Organiser:                                                                                                                      

Estimated Event Revenue*: $                                               

*This means all monies you expect to be paid from every source arising out of the event(s) to be insured.

Estimated Event Expenses*: $                                             

*This is the costs and charges you expect to incur in connection with the event(s) to be insured, including but not limited to deposits and other charges paid (or contracted to be paid) by you for transport, catering services, property and equipment rentals, hall and location rentals, accommodations (including travel arrangements).

Your History

(1) After investigation, have you or any principal, partner, or director, either alone or jointly with others ever, in the last 5 years:

(a) Had any insurance declined or cancelled, application/proposal rejected, renewal refused, claim rejected, or special conditions imposed by an insurer? Yes/No

(b) Been charged with or convicted of any criminal offence? (excluding traffic offences) Yes/No

(c) Been declared bankrupt or subject to any form of insolvency administration? Yes/No

If You answered Yes to any of the above questions please provide full details:

                                                                                                                                                                                                                                                                                   

                                                                                                                                                                                                                                                                                   

                                                                                                                                                                                                                                                                                   

                                                                                                                                                                                                                                                                                   

                                                                                                                                                                                                                                                                                   

Declaration and Authority

This declaration must be completed and signed by or on behalf of all parties applying for insurance.

I/We

(a) declare that:

(i) the answers and information given by me/us in this Proposal and any addendum are true and correct in all respects;

(ii) no information has been withheld that would affect [Your insurance company name] decision to accept this Proposal;

(iii) where answers in this Proposal are not in my/our own handwriting, they have been checked by me/us and I/we agree they are correct;

(iv) I/we have read and understood the clauses detailed under the Important Notices section at the back of this Proposal;

(v) if there was insufficient space to fully answer any questions, we have attached supplementary pages providing the additional information required.

(b) authorise [Your insurance company name] to give to, or obtain from other insurers or an insurance or credit reference bureau, any information relating to these insurance covers, and any other insurances held by me/us and claims under those insurances. 

(c) understand that, if this Proposal is accepted, my/our insurance cover will be subject to the terms and conditions set out in the applicable Arena Policy wording.

(d) acknowledge that Arena, its agents and/or employees reserve the right to decline this Proposal.

 

Proposer's Signature:                                                                                                     Date:                       /                       /                     

Position Held (e.g. director):                                                                                 

 

Completed proposals should be forwarded to your insurance broker or [Your company name] at [Your company name email address]