[Your company name, ABN, address, phone number, fax number, website, email]
ENTERTAINMENT AND EVENTS LIABILITY INSURANCE
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:
If you do not comply with your duty of disclosure, we may be entitled to:
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]
Taxation Information
The amount of cover available under this Policy excludes Goods and Services Tax (GST).
If you are not registered for GST, in the event of a claim we will reimburse you the GST component in addition to the amount that we pay.
The amount that we are liable to pay under this Policy will be reduced by the amount of any input tax credit that you are or may be entitled to claim for the supply of goods or services covered by that payment.
If you are entitled to an input tax credit for the Premium you must inform us of the extent of that entitlement at or before the time you make a claim under this Policy. We will not indemnify you for any GST liability, fines or penalties that arise from or are attributable to your failure to notify us of your entitlement (or correct entitlement) to an input tax credit on the Premium.
If you are liable to pay an Excess under the Policy, the amount payable will be calculated after deduction of any input tax credit that you are or may be entitled to claim on payment of the Excess.
If you are unsure about the taxation implications of this Policy, you should seek advice from your accountant or tax professional.
Don't Prevent Our Right of Recovery
The Liability Policy contains a provision which states that if You surrender Your right to seek recovery from another party a loss covered by the Policy, We have a right to reject any claim from You in relation to that loss.
ENTERTAINMENT AND EVENTS LIABILITY INSURANCE
PLEASE ANSWER QUESTIONS FULLY, USE BLOCK LETTERS AND TICK APPROPRIATE BOXES
Details of the Insured
Insured Name:
Trading Name:
Tax Registered Business: (Yes, No ABN No. Input Tax Credit: %)
Situation Address: Postcode:
Postal Address: Postcode:
Business phone No.: Fax No.:
E-mail:
Period of Insurance: From: / / at 4pm To / / at 4 pm
Your General History
1. Has any Insurer ever declined to insure You? Yes/No
2. Has any Insurer ever declined to renew any of Your insurances? Yes/No
3. Has any Insurer ever required special terms before insuring you? Yes/No
4. Name of Your previous public/products liability insurer:
5. Expiry date of previous policy: / /
If 'Yes' to any of the above questions, please provide full details. For claims or uninsured losses, please detail the total cost of the claim, date of loss, how the loss occurred, the name of the Insurer and the policy number.
Claims History
6. Have any claims been made against You in respect of Your legal liability for injury or damage in the past 5 years? Yes/No
If yes, please provide the following details:
Date of Incident Nature of Injury/Damage Amount of claim $
7. Are you aware of any circumstances which may give rise to a claim in the future? Yes/No
If yes, please provide details.
Details of the Business
8. Please provide the address or location of where you will be predominantly carrying out your business activities:
9. Do you carry out any activities outside of Australia? Yes/No
If yes, please provide names of countries.
10. Please describe all your business activities to be insured:
11. Please tick one or more of the following to best describe your business activities:
Entertainer/ performer musician/band etc.
Theatre/performance group
Drama/dance school
Booking agency
Event organiser/Concert promoter
Market Organiser
Community group/non-profit Organisation
Film or video production
Public Address, Lighting, Audio Visual, Staging or Rigging
12. How many years experience do you have in this field and/or how long has your business been operating?
13. Will your activities include the use of any of the following:
Registered motor vehicles: Yes/No
Watercraft: Yes/No
Aircraft or hovercraft: Yes/No
14.Will you be directly responsible for the supply and set up of staging systems? Yes/ No
15. Will you be conducting any rigging activities which require a rigger's ticket? Yes/No
16. Do you use contractors/sub-contractors? Yes/No If so, what activities will your contractors carry out?
17. Do you insist on your contractors/sub-contractors carrying their own public liability insurance? (This will be a condition of cover) Yes/No
Do you obtain evidence of same? Yes/No
18. Please advise the estimated:
(a) wages/turnover of your business for the next 12 months: $
(b) payments to contractors/subcontractors for the next 12 months: $
(c) number of employees:
(d) total number of members (if you are a non-profit organisation):
19. Have you entered into any Contracts or Agreements under which You have assumed liability for which You would not otherwise be liable, or under which You would not otherwise be liable, or under which You have waived Your legal rights of recovery (e.g.: Hold harmless or Indemnity Agreements)? Yes/No
If Yes, please provide copies of the Contracts or Agreements.
Note - a hold harmless or indemnity is whereby one party assumes the liability risks of another party under contract. Your public liability policy is to cover your legal liability & no one else's, therefore claims arising from these agreements are excluded. In some circumstances, your policy can be amended to include cover for these agreements providing your Insurer can review them & agree to their content. If you sign these agreements without first referring them to your Insurer, you may not be covered in the event of a claim.
20. Will you require cover for liability claims arising from loss or damage to other people's property whilst in Your Care, Custody or Control? Yes/No
If Yes, please advise the Limit of Liability required for any one period of insurance? $
Note - the above extension only operates if you are negligent in causing the loss or damage to the property in your care, custody or control. There can be situations where you have hired or borrowed other people's property, & suc property is lost or damage not as a result of your negligence. However, you may still be responsible for compensating the owner for their loss. In these circumstances, it would be prudent not to rely on the above extension on it's own but also insure the hired or borrowed property under a General property insurance policy, which will operate regardless of fault or negligence.
Insurance Required
21. Please tick the limit of indemnity required:
$ 5,000,000
$10,000,000
$20,000,000
22. Period that cover is required for:
Annual period Dates: From: To
Annual period Dates: From: To
ONLY COMPLETE THIS SECTION IF YOU ARE A MUSIC GROUP, BAND, ENTERTAINER, PERFORMING GROUP, DANCE OR DRAMA SCHOOL
For dance, drama, performing arts tuition, please answer the following:
23. Please provide the following details:
(a) Total number of registered students?
(b) Number of students per class?
(c) How many classes per week?
(d) How many teachers/supervisors?
24. Do students participate in hazardous, strenuous or physical activities? Yes/No
If Yes, please describe the nature of these activities?
For all bands, entertainers, performing groups, dance & drama schools please answer the following questions:
25. Please provide the following details:
(a)Total number of musicians/performers?
(b) Estimated number of performances during an annual period?
(c)Estimated attendance at each performance?
26. Do you hire the venue to stage your performances or are you just booked to turn up and perform?
ONLY COMPLETE THIS SECTION IF YOU ARE INVOLVED IN FILM OR VIDEO PRODUCTION ACTIVITIES
27. What type of productions will you be filming?
Feature Films? Yes/No
Documentaries? Yes/No
TV Productions? Yes/No
Corporate videos? Yes/No
Private & public events or occasions? Yes/No
TV Commercials? Yes/No
Music video clips? Yes/No
Other productions? (Please describe)
28. If annual cover required, please advise estimated number of productions during next 12 month period?
29. Estimated number of filming days?
30. Please advise the estimated production budget:
For annual period if required: $
For one off or short term period: $
31. Will your productions involve the use of any of the following:
Fire, fireworks, pyrotechnics? Yes/No
Stunts or explosions? Yes/No
Dangerous activities? Yes/No (Please describe)
Aircraft, watercraft or motor vehicles? Yes/No
ONLY COMPLETE THIS SECTION IF YOU ARE STAGING AN EVENT OR CONCERT
35. Name of event
36. Date of event
37. Event times: From To
38. Please describe nature of event
39. Estimated ticket price (if applicable)
40. Estimated attendance at your event/events
(Please provide a total estimate if insuring more than one event)
41. Please advise if your event will involve any of the following activities (please attach an event program or schedule):
Live music/theatrical/dance/artistic performances: Yes/No
Will any members of the public or audience members participate in any sporting, acrobatic, physically strenuous or hazardous activities? Yes/No
Camping facilities available to patrons: Yes/No
Motor-sport activities or displays: Yes/No
Food or Market stalls: Yes/No
Amusement rides, devices or animal rides: Yes/No
Please ensure that all amusement/animal ride contractors carry their own public liability insurance.
Fireworks or pyrotechnic displays: Yes/No
Name of Fireworks Operator:
Use of watercraft in your event: Yes/No
Use of aircraft in your event: Yes/No
42. Location where event is to be held
43. Is the event being held: Indoors/Outdoors
(For larger outdoor events, please provide layout plan of the venue etc.)
44. Is there any temporary seating structures being used? Yes/No
If yes, please ensure that the contractor responsible for supplying and setting up these structures carries their own public liability insurance.
45. Artists performing (If applicable)
46. If your event is a concert or performance, what style of music or performance is being performed?
47. Do you require annual cover for all events staged during annual period? Yes/No
If yes, please advise the number of events, concerts or performances to be covered?
(Please supply a separate schedule of events if possible)
48. Do you have a risk management plan or safety procedures for your event/events? Yes/No
(Please provide a copy of the plan if applicable)
49. Who will be responsible for security?
(Please ensure that the contracted security company carries their own public liability insurance)
50. Will you be serving, selling or supplying alcoholic beverages at your event? Yes/No
If yes, please advise
(a) Who is actually selling or serving the beverages?
(b) Do they carry their own liability insurance for this activity? Yes/No
(c) Who has signed the liquor license?
51. If your event is an exhibition or market, please provide number of stalls?
Will all stall holders or exhibitors carry their won liability insurance? Yes/No
(It is recommended that you insist on all stall holders or exhibitors to carry their own public and products liability insurance)
52. What type of products or services do the stall holders or exhibitors sell or display at your event?
Declaration
This declaration must be completed and signed by or on behalf of all parties applying for insurance.
I/We declare that:
(i) the answers and information given by me/us in this proposal are true and correct in all respects and that no information has been withheld which would affect [Your company's name] decision about accepting this insurance;
(ii) where answers in this Proposal are not my/our own handwriting, they have been checked by me/us and I/we agree they are correct;
(iii) I/we have read and understood the clauses detailed under the Important Notices of this Proposal;
(iv) if there was insufficient space to fully answer any questions, we have attached supplementary pages providing the additional information required;
(v) I/we authorise [Your 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;
(vi) I/we understand that if this Proposal is accepted, my/our insurance cover will be subject to the terms and conditions set out in the Applicable Policy;
(vii) I/we further acknowledge that [Your company name], their agents or employees reserve the right to decline this proposal.
Proposer's Signature:
Date: / /
Proposer's Name:
Proposer's Title:
Completed proposals should be forwarded to your insurance broker or [Your insurance company] at [Your insurance company email]