MAAIS Events Insurance Application

Fight Show / Tournament EVENTS Insurance Quote

Martial Arts Australia Insurance Services ABN:31 632 785 329Corporate Authorised Representative: 001283262 of United Insurance Group Pty Ltd ABN 31 131 564 522 Australian Financial Services License: AFSL 327131
SELECT THE TYPE OF INSURANCE YOU REQUIRE*

STANDALONE EVENT POLICY- 10mil Public Liability (PL)STANDALONE EVENT POLICY- 20mil Public Liability (PL)EVENT ENDORSEMENT - Add an event onto your existing Public Liability policyINSURANCE HEALTH CHECK - Not Sure What You Need - Want To Discuss
Contact Name*

First NameLast Name
Insured Business Name - School / Legal Trading Entity:*
Type of Sport/Martial Arts
Email*
example@example.com
Website
Mobile*
Phone
Address*

Street Address

Street Address Line 2

SuburbState

Postal Code

Past Claims Information*

	YES	NO
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)?

Type of event - fight show / tournament other - list below*
Number of competitors, officials, spectators - total per event*
EG: Up to 250, 250-500, 500-1000, 1000-1500
The number of events planned per year?*
What is the estimated total ticket sales revenue? (turnover)*
What is the total prize money of each show (cash not gifts / free tickets etc)*
Is the event sanctioned if so by which industry body?*
What rules are used in the competition?*

Operation Details*

	YES	NO
Do you have a risk management policy for your events? - if yes please make available upon request
Do you have a floor plan of the event you hire? - if yes please make available upon request.
Do you use your own security or that of the venue?
Have you run this type of events before?

Upload supporting documents, eg risk management, floor plan, etc.

Cancelof
Date you require Insurance to Start*
DECLARATION
I/We the undersigned duly authorised person(s) declare that:
i. I am/we are authorised by each of the Proposers to sign this Proposal Form; and
ii. the above statements are correct, true and complete; and
iii. no information material to this Proposal Form has been withheld; and
iv. I/we have read the important facts which you have put before me/us and I/we understand the advice given in relation to the duty of disclosure; and
v. I/we have diligently made all necessary and detailed enquiries in order to comply with the duty of disclosure; and
vi. I/we understand that no insurance is in force until such time as the insurer has confirmed acceptance of the proposed insurance; and
vii. I/We undertake to inform the insurer of any material alteration to these facts occurring before completion of the contract of insurance; and
viii. I/we acknowledge that the Insurer relies on the information and representations in this Proposal Form and otherwise made by me/us in relation to this insurance.
Signature

Clear
Name

FULL NAMEDATED
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)
Should be Empty:

Fight Show / Tournament EVENTS Insurance Quote