1. Your (Business) Name:(required)
Contact Name: (required)
3. State: (required)
5. Policy $ currency:
6. Type of event (eg conference, festival, cricket etc:)
7. Event name:
11. Event start date:
12. Event end date:
13. Tenancy start date:
14. Tenancy end date:
15. Has this event been held before?
16. Is the event open to the public?
17. Please enter the budget information for this event:
a) 100% Gross Revenue (Total Income)*: $
* Please note that if the event has not been held before, revenue cover is limited to pre-contracted gross revenue only (money secured in advance of the event such as pre sold tickets)
b) 100% Costs and Expenses: $
c) Please tick to confirm the basis of insurance you required:
100% Gross Revenue100% Cost & Expenses
18. Where does this event take place? (Please Select One)
Predominantly* IndoorsPredominantly* outdoorsPredominantly* in temporary structures
*Predominantly means more than 75% of the event
19. If outdoors or in temporary structures, is cover required for the effects of adverse weather?
20. If yes to 19, can the event go ahead in continuous moderate rainfall and wind speeds
of up to 30mph/50kmh?
21. Does the event site have any history of flooding or water logging?
22. Has this event ever had any losses as a result of adverse weather, whether insured or not?
23. Will any stages, marquees or temporary structures be covered on three sides and above,
with all electrical equipment protected from weather?
24. Is non-appearance cover required?
25. Type of non-appearance cover required?
a) Key speaker (key speakers, presenters, hosts involved in a speaking only role)-(If so, please complete Question 26)b) Individual/Group (performers, groups or entertainers)-(If so, please complete Question 26)c) Simultaneous (Covers 25% of participants* due to Common Cause)-(If so, please complete Question 27)
*Participants are defined as players, athletes, performers or other groups of individuals who are contracted to perform at the event and whose performance is critical to its successful fulfilment
26. Key speaker/Performer details
27. Are there 20 or more participants* in total?
Public Liability (Only complete if Public Liability cover is required)
28. Event Liability Limit
29. Maximum Daily Attendance
30. Total Attendance
31. Do you have any assets in the USA?
32. Does the Event include any dangerous activities*?
*Dangerous activities include, but are not limited to: Fireworks, bonfires, pyrotechnical devices, inflatable play equipment, fairground rides or mechanically propelled rides of any kind, ballooning, quad bikes, go-karts or motor sport of any kind, trampolines or gymnastic apparatus of anykind, circus acts or stunt acts, shooting ranges for guns or archery.
Bouncy castles, inflatable play equipment, slides or rides (mechanical or otherwise) which are set up, operated and taken down by a bona fide sub contractor who has provided you with evidence of their current public liability insurance, shall not be classed as dangerous activities
33. If Yes, do you supply or manage any of these yourselves, and if so, which?
34. If No to question 33, has proof of insurance been obtained from the 3rd party contractors who provide, operate or supply any of these activities?
35. Are there any other activities taking placeat the event which need to be considered?
If so, please provide full details of the activities including safety measures and confirmation as to whether the Insured provides or operates any activity or equipment themselves, or if they are provided, operated and supplied by fully insured 3rd party contractors
36. Will all contractual arrangements necessary for the successful fulfilment of each event be made and confirmed in writing in a prudent timely manner prior to the start of the event?
37. Has any event to be insured had any incidents that could have resulted or did result in a loss which would have been covered under this Insurance during the past 5 years?
38. Are you aware of any matter, fact, circumstance or incident existing or threatened that could
possibly affect any event and might result in a claim under the proposed Insurance?
I/we declare that the information disclosed on this proposal, is to the best of my/our knowledge and belief both accurate and complete. I/we have taken care not to make any misrepresentation in the disclosure of this information and understand that all information provided is relevant to the acceptance and assessment of this insurance, the terms on which it is accepted and the premium charged.
You must tell us as soon as possible about any changes in this information you have provided to us which happens before or during any period of insurance. We will tell you if such change affects your insurance and if so, whether the change will result in revised terms and/or premium being applied to your policy. If you do not inform us about a change it may affect any claim you make or could result in your insurance being invalid.
39. Have any claims for personal injury or damage to property by third parties or employees been made against You in the past 5 years?
You Declare that You:
Signature (sign this declaration for all sections selected)
I/We declare that the information provided above and in all appending sections is true to the best of My/Our knowledge.