Step 1 of 3 33% DetailsName of ClubContact NameAddressSuburb/TownStateACTNSWNTQLDSATASVICWAPostcodeEmail TelephoneEstimated Annual TurnoverDescribe all activitiesDo you use weapons?YesNoIf yes, please describeAre your activitiesChoose one...Full contactSemi contactNon contactPlease detail style of martial arts undertakenAikido %karate %Muay Thai %Tang So Do %Boxing %Kempo %Ninjitso %Wrestling %Hapkido %Kendo %Qi Gong %Yoga %Judo %Kickboxing %Taekwondo %Jujitsu %Brazilian Jujitsu %Kung Fu %Tai Chi %Others(details below) %OtherTotal (must equal 100%)*Which industry bodies are you accredited with? %Public Liability InsuranceDo you require a quotation for Public Liability Insurance?YesNoDo You:Host international eventsYesNoOwn the premisesYesNoHire the premises out to othersYesNoOwn the equipment usedYesNo Hire out the equipment to othersYesNoHave a liquor licenseYesNoOwn or operate a cafeteriaYesNoManufacture goodsYesNoSell goods to the publicYesNoEnter into any contractual agreementsYesNoIf you have answered YES to any of the questions above, please provide details:Number of MembersNumber of tournaments organised by you per year?Public Liability Limit of Indemnity required?Choose one...$2m$5m$10m$20mProfessional Indemnity limit of requiredChoose one...$1m$2m$5mPeriod of Insurance-Start Date Format: MM slash DD slash YYYY Period of Insurance-End Date Format: MM slash DD slash YYYY Have you had any previous claims?YesNoIf yes, please provide detailsNumber of instructorsAre all instructors qualifiedYesNoIf yes, please provide detailsPersonal Accident InsuranceTotal number of membersNumber of senior membersNumber of junior membersHave you had any previous claims?YesNoIf yes, please provide detailsType of cover requiredStandardBudgetCapital Benefits onlyProperty InsuranceProperty AddressSuburb/TownStateACTNSWNTQLDSATASVICWAPostcodeApproximate age of premises (yrs)Renewal Date Date Format: MM slash DD slash YYYY PremiumAre the buildings constructed only of brick, stone, concrete or other non combustable mateirals and roofed with slates, tiles, concrete or other non-combustable materials?YesNoIf the answer to the above is no, please provide full details of construction and advise what percentage of the building does not comply with the above construction.Are the premises occupied solely by yourselves?YesNoIf no please provide detailsAre the premisesChoose one...DetachedSemi DetachedTerracedAre the premisesChoose one...ResidentialCommercialIndustrialRural Sum InsuredBuildingOther BuildingsContentsStockWines/Spirits/TobaccoTrophiesMoneyBusiness Interuption - Gross RevenueBusiness Interuption - Book DebtsBusiness Interuption - Increased cost of workingBusiness Interuption - Loss of licenceAre all accessible doors deadlocked?YesNoAre all accessible windows grilled/barred?YesNoDo all accessible windows have key-operated window locks?YesNoAre the premises alarmed?YesNoIs it monitored?YesNoIs it back to base?YesNoHave you had any previous claims?YesNoIf yes, please provide detailsAdditional InformationAdditional Information* I confirm that the details I have entered are correct
