Special Events Insurance   AUSTRALIAN & NEW ZEALAND NATIONWIDE INSURANCE SERVICES
Sydney • Brisbane • Melbourne • Adelaide • Perth • Wellington • Auckland 		 
Home   |   About Us   |   Life & Income Protection   |   Claims   |   Pay Online   |   Career   |   Consumer   |   Contact Us
  
Special Event Proposal - Insurance NEEDS ANALYSIS FORM
This form is designed to gather general information from which to present to various underwriters to obtain an indicative quote. You will most likely have to provide further information in due course.

If your requirements exceed the scope of this form, please contact us for direct personal assistance. 		Terms and Conditions

EVENT DETAILS -
Section 1

1) Name of Proposer?
(As you want it to appear on the policy)
     
2) Name of Event?
     
3) Type of Event & Activities at the Event?
(Please give detailed description)
     
4) Where will the Event be held?
(If more than one Event Please provide details for each)
 
Location Date From - To Estimated No. of Attendees
     
5) Is the Event being held indoors or outdoors?
(Please provide some details)		 Indoor      Outdoor
     
6) Are there any temporary seating and/or structures
being used?		    Yes      No
   
(If Yes, please provide details, including
contractors/suppliers details)
     
7) Will the persons attending the special Event "Attendees" pay any money to attend the event?    Yes      No
   
(If Yes, please provide details)
     
8) What is the Proposer’s past experience at running this type of event?
     
9) Will food be sold at the Event?    Yes      No
     
(If Yes, please provide details of the types of food, cooking processes and the suppliers)
     
10) Will alcohol be sold at the Event?    Yes      No
     
(If Yes, please provide details of who will provide and dispense the alcohol, including licensing arrangements etc.)

Please note a separate"Alcohol Questionnaire" may be required to be completed.
     
11) The next question a) to d) relates to providers of event production services (contractors/suppliers). (Providers of Event production services ought to have their own Public Liability Insurance - Please confirm that Contractors / Suppliers will have their own Public Liability Insurance in place?)
     
a) Food & Alcohol Providers
   
    Their own limit of Public Liability Insurance:    Yes      No

    The limit of Public Liability Insurance Cover: $
   
    Will you be listed on their cover as an interested party?:    Yes      No

     
b) Vendors / Exhibits
   
    Their own limit of Public Liability Insurance:    Yes      No

    The limit of Public Liability Insurance Cover: $
   
    Will you be listed on their cover as an interested party?:    Yes      No

     
c) Contractors / Others
   
    Their own limit of Public Liability Insurance:    Yes      No

    The limit of Public Liability Insurance Cover: $
   
    Will you be listed on their cover as an interested party?:    Yes      No

     
d) Security
   
    Their own limit of Public Liability Insurance:    Yes      No

    The limit of Public Liability Insurance Cover: $
   
    Will you be listed on their cover as an interested party?:    Yes      No

     
12) Will there be entertainment at this event?    Yes      No
     
(If Yes, please describe the type of entertainment)
     
13) Will the Performers be required to carry their own public liability insurance?    Yes      No
   
(If Yes, what will be the minimum limit of indemnity required - and how much?)
     
14) Will there be security at the Event?    Yes      No
   
(If Yes, who will be providing security, please provide details.)
     
15) Do you have a risk management plan?
(It would be great if you could attach a copy with this form) 		   Yes      No



LIMIT OF PUBLIC LIABILITY INSURANCE REQUIRED -
Section 2

16) a) Limit of Public Liability Insurance required:    $5,000,000     $10,000,000     $20,000,000
     
b) Please state the excess required (in most cases an excess is compulsory)
   $500           $2,500            $5,000         Other
     
17) Usually this type of public liability insurance will cover you for the duration of the Event, including for the 24 hours before and after the stated Event start time and finish: Duration of cover required?
From Date:
     To Date:
     
18) Do you require a longer duration of insurance cover for the 24 hours before and after the stated Event start time and finish:?    Yes      No
     
(If Yes, please state the duration of cover required
and why?)
     
19) Do you require the Public Liability to Cover Volunteers?    Yes      No
     
(If Yes, please provide details)

We may require more information in due course.
     
20) Does the Proposer require insurance cover for any of the following risks? (We may require a separate application):
   
   Cancellation Insurance    Yes      No
   Money & Fidelity Insurance    Yes      No
   Material Damage to Property & Goods    Yes      No
   Pluvious Insurance (Rain Out Cover)    Yes      No


PROPOSER’S DETAILS -
Section 3

21) Name of person completing this proposal?
     
22) Is the Proposer a Corporation - Community Group, or Individual?
     
23) If a Corporation, please provide an
ABN or ACN?


DISCLOSURE & ACKNOWLEDGEMENT -
Section 4

24) Have you or any person associated with the management or organisation of this Event ever:?
   
 
a) Had a Legal Liability claim made upon you or the other person?    Yes      No
b) Ever made a claim for insurance in respect of the type of cover you require?    Yes      No
c) Been refused insurance?    Yes      No
d) Had an insurance claim of any type refused or reduced?    Yes      No
e) Been charged with a crime of any type?    Yes      No
     
25) Is there anything else you would like to request? - Is there anything else you would like to tell us that may be important?


APPLICANT’S ACKNOWLEDGEMENT -
Section 5

1. The Duty of Disclosure, Non-Disclosure and Inadequate Space to Answer notices set out above have been read by me/us.
2. All answers and statements made in this application are true and accurate in every respect and no information has been withheld which is likely to affect the Underwriter’s decision about accepting this insurance.
3. I acknowledge the Underwriter reserves the right to decline any application.

Please examine your Duty of Disclosure

I agree to the above terms


DECLARATION


Although the signing of this Proposal does not bind the Applicants to effect insurance, the Applicants acknowledge that the particulars and statements contained in this Proposal and in the accompanying documents shall be the basis of the contract should a Policy be issued; and further, the Applications acknowledge that the Proposal and the accompanying documents will be incorporated in the Policy.


CONTACT DETAILS
Section 6


Postal address if different from above
[Include Postcode and State]
Business Telephone [Include Area Code]
Facsimile [Include Area Code]
Mobile
Email Address
Do you have any other comments/requirements?

Can we help you with anything else while you are exploring insurance options?

What about Workers Compensation Insurance
What about Life & Accident Insurance
What about Financial Planning
For qualifications concerning the information on this page, please click here.
© Copyright 2007 Rural & General Insurance Broking Pty Ltd. All Rights Reserved. Website design and SEO by Netmastery