Step 1 of 3 33% DetailsName of ClubContact NameAddressSuburb/TownStateACTNSWNTQLDSATASVICWAPostcodeEmail TelephoneEstimated Annual TurnoverDescribe all activitiesDo you use weapons? Yes No If 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 No Do You:Host international events Yes No Own the premises Yes No Hire the premises out to others Yes No Own the equipment used Yes No Hire out the equipment to others Yes No Have a liquor license Yes No Own or operate a cafeteria Yes No Manufacture goods Yes No Sell goods to the public Yes No Enter into any contractual agreements Yes No If 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 Period of Insurance-End Have you had any previous claims? Yes No If yes, please provide detailsNumber of instructorsAre all instructors qualified Yes No If yes, please provide detailsPersonal Accident InsuranceTotal number of membersNumber of senior membersNumber of junior membersHave you had any previous claims? Yes No If yes, please provide detailsType of cover requiredStandardBudgetCapital Benefits onlyProperty InsuranceProperty AddressSuburb/TownStateACTNSWNTQLDSATASVICWAPostcodeApproximate age of premises (yrs)Renewal Date 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 No If 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 No If 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? Yes No Are all accessible windows grilled/barred? Yes No Do all accessible windows have key-operated window locks? Yes No Are the premises alarmed? Yes No Is it monitored? Yes No Is it back to base? Yes No Have you had any previous claims? Yes No If yes, please provide detailsAdditional InformationAdditional Information* I confirm that the details I have entered are correct
Leave a Reply
Want to join the discussion?Feel free to contribute!