Request for a Public Liability & Indemnity Quote
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Required fields
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Contact Name:
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Organisation Name:
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Postal Address:
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Suburb/Town:
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Postcode/Zipcode:
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State/County/Province:
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Country:
Phone no:
Fax no:
Email Address:
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Sport:
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Period of Insurance:
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2003
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2015
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2015
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2019
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Activities Undertaken by the Club, ie the Sport:
Is the Club Incorporated?
NO
Yes
Does the Club/Association Own the Above Premises?
NO
Yes
Hire out those Premises?
NO
Yes
Own the Equipment Used?
NO
Yes
Hire out the Equipment?
NO
Yes
Operate Licensed Premises?
NO
Yes
Sell Goods to the Public?
NO
Yes
Is there a Grandstand?
NO
Yes
Host International Events?
NO
Yes
If you answered YES to any of the above, please provide full details:
Has the Club/Association entered into any contractual agreements?
NO
Yes
If YES, Please provide full details:
Number of Events/Meetings/Games per year:
Number of Spectators at each Event/Meeting/Game (Average):
Approximate duration of season:
Number of Committee Members and Officials:
Number of Registered Non-Playing Members:
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Number of players/teams to be covered and which type of cover required:
Members(PL/PI Cover) $2 Million
Members(PL/PI Cover) $5 Million
Members(PL/PI Cover) $10 Million
Current Insurer:
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Have you had any claims in the past 3 years?
NO
Yes
If you clicked "YES" in the
previous question, please
give details of claims:
Any other Relevent Information:
OR
