MAAIS Insurance Application

Martial Arts Insurance Quote Application

Martial Arts Australia Insurance Services Pty Ltd ABN: 31 632 785 329 AFSR No: 001283262 Authorised Representatives of Marsh Advantage Insurance Pty Ltd - AFSL: 238369
SELECT THE TYPE OF INSURANCE YOU REQUIRE *

STANDARD PACKAGE 1- 10mil Public Liability (PL) 5mil Professional Indemnity (PI) STANDARD PACKAGE 2- 20mil Public Liability (PL) 5mil Professional Indemnity (PI) PREMIUM PACKAGE 1- 10mil (PL) & (PI) + Player Accident & Income Protection PREMIUM PACKAGE 2- 20mil (PL) & (PI) + Player Accident & Income Protection MANAGEMENT LIABILITY- 1 million BUSINESS PACK- Property / Contents / Business Interruption / Glass Breakage INSURANCE HEALTH CHECK - Not Sure What You Need - Want To Discuss
Contact Name *

First Name Last Name
Insured Business Name - School / Legal Trading Entity: *
Additional Persons / Instructors Names to be listed on Policy:
*Note all instructors are covered and are not required to be named and listed.
More Entities? Interested Parties? Add them:
Email *
example@example.com
Website
Mobile *
Phone
Address *

Street Address

Street Address Line 2

Suburb State

Postal Code
NSW ONLY - Are you a small business eligible for the exemption from the requirement to pay NSW duty on certain types of insurance? If yes we deduct the stamp duty off the invoice.

YES NO

Past Claims Information *

YES

Are you aware of any insurance being declined or cancelled, application/proposal rejected, renewal refused, claim rejected, or special conditions or excess imposed by any insurer?

Are you aware of any claims made against you in the past 5 years?

Have you had an incident or accident which would be insured by the proposed insurance?

Are you aware of anyone having been charged with or convicted of any criminal offence (excluding traffic offences)?

Have you ever, either alone or jointly with others, been declared bankrupt or subject to any form of insolvency administration (e.g. liquidation or receivership)?

Training / Coaching Experience *

5 years and over

1 to 5 years

NEW

How many years experience does the Insured have?

How established is the Insured's Business?

What qualifications do you currently hold that are relevant to the Insured Activities? *

Black belt/Purple sash or higher? Strength and Conditioning Coach RTO/TAFE Instructor Recognition Professional Affiliations Working with Children Check Certificate IV in Fitness (or higher) NSO Accredited Coaching Qualification Gym Instructor, Group Fitness Instructor First Aid Certificate Police Check

Operation Details *

YES

Does the Insured, including Employees and freelance coaches/instructors if engaging them, hold industry recognised qualifications and suitable experience that is/are relevant to The Business activities of the Insured?

Does the Insured use documented risk management procedures, incident report register, participant waivers, OHS/WHS policies and procedures?

If instructing at third party premises, does the Insured carry out an assessment to ensure the space is fit for purpose prior to any instructing?

Is the Insured's facility ever unsupervised by staff when open for use?

Does the Insured operate any warrior, ninja or parkour training or classes?

Does the Insured have a Creche?

On an average per week, how many people do you train / workout at your facility? *
On an average per week, how many classes do you run? *
Estimated yearly turnover across all locations - Only required if you lease or own your training facility. *
Date you require Insurance to Start *

How many Schools/Centres does the Insured own/operate? Insert the number of schools and the state they are located in-

NSW

QLD

VIC

TAS

ACT

Number of Schools

This application form will be used to create a letter of offer for the nominated insurances you have selected. Upon your acceptance of this offer we will create the rest of documents (invoice / certificate of currency etc)

Payment Methods: Our invoice has all the payment options for you.

Send all correspondence to: Martial Arts Australia Insurance Services
Office: 6 / 12 Henderson Road, Knoxfield VICTORIA
Postal: P.O Box 2057 Blackburn South VICTORIA 3130
DISCUSS - P: 03 8201 9908 URGENT: 0451 331 958 (Text 24/7)
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Martial Arts Insurance Quote Application