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TATTOOIST LIABILITY COVER
INDIVIDUALS
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1
DUTY OF DISCLOSURE
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Ok, so before we start we need to tell you some things... Yes it's boring, but we need to do this and it only takes 1 minute. Your Duty of Disclosure is your obligation to be honest and tell us anything that is known to you and which a reasonable person would include in the answer to the questions we ask. This includes information that you may provide about other people who are seeking to be covered under a Contract of Insurance. E.g. other owners, contractors and apprentices. To make an accurate assessment of the risk, Insurers must be confident that the information disclosed is representative of the facts. If the information is not true, it is a misrepresentation. As per Sections 21 and 21A of the Insurance Contract Act, you must: - disclose matters that you know to be relevant to the policy, and - disclose matters that a ‘reasonable person in the circumstances would know to be relevant to the insurer. Under section 11 of the Act, your Duty of Disclosure applies when: - the policy contract is entered into, - at renewal, - if the policy is extended or reinstated, and - if you vary your policy via endorsement. It is important to understand that an Insurer can avoid a Contract of Insurance where the insured (that's you) or the insured’s broker (that's us) has misrepresented the facts that an Insurer has relied upon when deciding on whether to offer a Contract of Insurance and on what terms.
I AGREE
I DON'T AGREE
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2
Let's start with your name
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First Name
Last Name
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3
What is your ABN?
ABN Look Up
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4
Address
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Street Address
Street Address Line 2
City
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QLD
NSW
VIC
ACT
SA
WA
NT
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QLD
NSW
VIC
ACT
SA
WA
NT
State
Post Code
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United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
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Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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5
Phone Number
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Please enter a valid phone number.
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6
Email
*
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example@example.com
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7
Date you want the insurance to start
*
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-
Date
Day
Month
Year
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8
What is your annual turnover?
*
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9
What limit do you want for Public Liability?
*
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$10 Million
$20 Million
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10
Sterilisation and aftercare questions
*
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Please answer yes or no to the following questions
YES
NO
Are instruments and equipment sterilised frequently?
Row 0, Column 0
Row 0, Column 1
Are new needles used for each session?
Row 1, Column 0
Row 1, Column 1
Is each client provided with written aftercare instructions?
Row 2, Column 0
Row 2, Column 1
Are instruments and equipment sterilised frequently?
Are new needles used for each session?
Is each client provided with written aftercare instructions?
YES
Row 0, Column 0
NO
Row 0, Column 1
YES
Row 1, Column 0
NO
Row 1, Column 1
YES
Row 2, Column 0
NO
Row 2, Column 1
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11
Additional activity questions
*
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Please answer yes or no to the following questions
YES
NO
Do you preform any cosmetic tattooing?
Row 0, Column 0
Row 0, Column 1
Do you use the hand tapping method of tattooing?
Row 1, Column 0
Row 1, Column 1
Do you do any tattooing of the eye ball?
Row 2, Column 0
Row 2, Column 1
Do you offer any type of branding or scarification services?
Row 3, Column 0
Row 3, Column 1
Do you preform any cosmetic tattooing?
Do you use the hand tapping method of tattooing?
Do you do any tattooing of the eye ball?
Do you offer any type of branding or scarification services?
YES
Row 0, Column 0
NO
Row 0, Column 1
YES
Row 1, Column 0
NO
Row 1, Column 1
YES
Row 2, Column 0
NO
Row 2, Column 1
YES
Row 3, Column 0
NO
Row 3, Column 1
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12
Liability questions
*
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Please answer yes or no to the following questions
YES
NO
Do you have all clients sign release stating they are at least 18, understand the procedures and are not under the influence of drugs or alcohol?
Row 0, Column 0
Row 0, Column 1
Do you have private booths for discreet tattoos?
Row 1, Column 0
Row 1, Column 1
Have you ever had any incidents involving disorderly conduct or sexual misconduct?
Row 2, Column 0
Row 2, Column 1
Do you have all clients sign release stating they are at least 18, understand the procedures and are not under the influence of drugs or alcohol?
Do you have private booths for discreet tattoos?
Have you ever had any incidents involving disorderly conduct or sexual misconduct?
YES
Row 0, Column 0
NO
Row 0, Column 1
YES
Row 1, Column 0
NO
Row 1, Column 1
YES
Row 2, Column 0
NO
Row 2, Column 1
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13
Do you do tattoo removal?
*
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NO
YES
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14
What type of procedure is used for tattoo removal. i.e.: Laser
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15
Do you do piercing activities?
*
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NO
YES
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16
Piercing questions
*
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Please answer yes or no to the following questions
YES
NO
Are new needles used for each session?
Row 0, Column 0
Row 0, Column 1
Is each client provided with written aftercare instructions?
Row 1, Column 0
Row 1, Column 1
Do you have private booths for discreet piercings?
Row 2, Column 0
Row 2, Column 1
Are new needles used for each session?
Is each client provided with written aftercare instructions?
Do you have private booths for discreet piercings?
YES
Row 0, Column 0
NO
Row 0, Column 1
YES
Row 1, Column 0
NO
Row 1, Column 1
YES
Row 2, Column 0
NO
Row 2, Column 1
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17
Do you do genital piercing?
*
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NO
YES
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18
How many years experience have you had at genital piercing?
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19
Do you have apprentices?
*
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NO
YES
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20
Are they fully supervised at all times?
*
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NO
YES
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21
What is the name/s of your Apprentice/s
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22
Are you required to be licenced by the State or Local government?
*
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NO
YES
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23
What is your licence number?
*
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24
Do you or your business partner(s) have or ever had any affiliations with Outlaw Motor Cycle Gangs (OMCG)?
*
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NO
YES
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25
(OMCGs) Please provide us with more information?
*
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26
Does any OMCG, or member of an OMCG have a financial or beneficial interest in your business?
*
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NO
YES
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27
(OMCGs Financial Interest) Please provide us with more information?
*
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28
Are there any person/s not named on this proposal that have a financial or beneficial interest in the business?
*
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NO
YES
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29
Please provide more details?
*
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30
Have you been convicted of any criminal offence within the past 5 years (other than minor traffic convictions)?
*
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NO
YES
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31
(Criminal offences) Please provide more details?
*
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32
Have you been liable for any civil offence or pecuniary penalty (exceeding $5,000)?
*
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NO
YES
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33
(Civil offence or fines over $5k) Please provide more details?
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34
Have you had any claims made against you (whether insured or not) or have you recalled any of your products during the last 5 years?
*
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NO
YES
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35
(Claims and Recalls) Please provide more details?
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36
Have you made any claims for loss or damage during the past 5 years?
*
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NO
YES
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37
(Loss/Damage) Please provide more details?
*
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38
Have you had any insurance declined or cancelled, proposal or application rejected, renewal refused, claim rejected, special conditions or excess imposed by an insurer?
*
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NO
YES
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39
Please provide more details?
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40
Have you or your partner(s) or director(s) of the business ever been declared bankrupt?
*
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NO
YES
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41
(Bankruptcy history) Please provide more details?
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42
Have you or your partner(s) or director(s) of the business ever been involved in a company or business which became insolvent or subject to any form of insolvency administration (eg. liquidation or receivership)?
*
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NO
YES
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43
(Insolvency history) Please provide more details?
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44
E-SIGNATURE AND DECLARATION
I declare that all answers and statements in this document are correct and complete in every aspect and no information has been withheld.
YOUR FULL NAME
DATE OF DECLARATION
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TATTOOIST LIABILITY COVER FOR INDIVIDUALS
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