Insured Name

Contact Person

Email Address

Web Address


Event Name

Event type

Postal Address

Venue Address

History of cancellation or abandonment due to adverse weather regardless if Insured or not:

Dates of Event(s) Hours of Event
(eg 10am to 10pm)
Hours of coverage
(eg 6am to 3pm)
Rainfall Limit (mm) required $Sum Insured Required

Special requests : (eg please also quote for rainfall in excess of 10mm,15mm and 20mm)

Coverage is subject to a completed application, full premium payment a minimum of 14 days prior to the Insured event and acceptance/approval of Underwriters.

Signature: Date:


Signing of this form does not bind you or the Underwriter to coverage however should you wish to proceed with cover the information herein and the answers you give will form part of the Insurance contract. Under the Insurance Contracts Act you are required to declare any matter which may affect the Underwriters decision whether or not to accept the Insurance risk. You are not required to declare any information that is of common knowledge or which the Insurer should know in the normal course of their business. (eg Rainfall statistics for your district are common knowledge)