Step 1 of 333%DetailsName of ClubContact NameAddressSuburb/TownStateACTNSWNTQLDSATASVICWAPostcodeEmail TelephoneEstimated Annual TurnoverDescribe all activitiesDo you use weapons? Yes NoIf 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? Yes NoDo You:Host international events Yes NoOwn the premises Yes NoHire the premises out to others Yes NoOwn the equipment used Yes NoHire out the equipment to others Yes NoHave a liquor license Yes NoOwn or operate a cafeteria Yes NoManufacture goods Yes NoSell goods to the public Yes NoEnter into any contractual agreements Yes NoIf 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 MM slash DD slash YYYY Period of Insurance-End MM slash DD slash YYYY Have you had any previous claims? Yes NoIf yes, please provide detailsNumber of instructorsAre all instructors qualified Yes NoIf yes, please provide detailsPersonal Accident InsuranceTotal number of membersNumber of senior membersNumber of junior membersHave you had any previous claims? Yes NoIf yes, please provide detailsType of cover requiredStandardBudgetCapital Benefits onlyProperty InsuranceProperty AddressSuburb/TownStateACTNSWNTQLDSATASVICWAPostcodeApproximate age of premises (yrs)Renewal Date 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? Yes NoIf 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? Yes NoIf no please provide detailsAre the premisesChoose one...DetachedSemi DetachedTerracedAre the premisesChoose one...ResidentialCommercialIndustrialRuralSum InsuredBuildingOther BuildingsContentsStockWines/Spirits/TobaccoTrophiesMoneyBusiness Interuption - Gross RevenueBusiness Interuption - Book DebtsBusiness Interuption - Increased cost of workingBusiness Interuption - Loss of licenceAre all accessible doors deadlocked? Yes NoAre all accessible windows grilled/barred? Yes NoDo all accessible windows have key-operated window locks? Yes NoAre the premises alarmed? Yes NoIs it monitored? Yes NoIs it back to base? Yes NoHave you had any previous claims? Yes NoIf yes, please provide detailsAdditional InformationAdditional Information* I confirm that the details I have entered are correct
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