MAAIS TRAVEL Insurance Application

MARTIAL ARTS TRAVEL INSURANCE - Quote Application

Martial Arts Australia Insurance Services Pty Ltd ABN: 31 632 785 329 AFS Representative No: 001283262 of United Insurance Group Pty Ltd ABN 31 131 564 522 AFSL 327131 COVERING MARTIAL ARTS TRAINING & COMPETING
Name of the insured*
Legal trading entity of the school / business
ABN
Contact Person's Name *

First NameLast Name
Email *
example@example.com
Mobile *
Postal Address*

Street Address

Street Address Line 2

SuburbState

Postal Code

Destination/s*
Countries of travel

Travellers Details*

	Full Name	Date of Birth	Competitor / Official	Departure Date	Return Date	Sporting Activity
Traveller 1
Traveller 2
Traveller 3
Traveller 4
Traveller 5
Traveller 6
Traveller 7
Traveller 8
Traveller 9
Traveller 10

Additional Travellers
More than 10 travellers - Please add details here: Name, DOB, Competitor / Official, Departure/Return Date, Sporting Activity, Travel Claims Y/N.

Claims History*

	Yes	No
Does the Insured currently hold or has previously held any Corporate Travel Insurance Policy?
Has the Insured or any proposed Insured Person lodged any Travel claims in the last five (5) years?
Has the Insured been declined Travel Insurance in the past?

If Yes, please give all details and attach an up to date claims experience(Date of Loss, Nature of Loss, Amount, Reasons for Declinature)

Important Notices

BINDER AGREEMENT
The contract of insurance is arranged by Batch Underwriting Pty Ltd (ABN 15 670 264 767, AFSL 237267) (‘Batch’) acting under a binding authority as agent for the Insurer(s), certain underwriters at Lloyd’s. Batch does not act as Your agent.

DEFINED TERMS
Some words used in this Proposal Form (‘Proposal’) have a special meaning as defined in the Policy wording and such other documents which make up the Policy which contain definitions. We, Us, Our, Insurer(s) means Certain Underwriters at Lloyd’s. You, Your, Insured means the person(s) or parties shown as the Insured in the schedule.

COMPLETING THE PROPOSAL FORM

1. This application must be completed in full including all required attachments.

2. If more space is needed to answer a question, please attach a separate sheet with details.

3. The terms proposer, whenever used in this proposal form shall mean the insured listed and all subsidiary companies
of the insured for which coverage is proposed under this proposal.

4. The terms insured and subsidiaries have the same meaning in this proposal form as in the policy.

YOUR DUTY OF DISCLOSURE
Before You enter into an insurance contract, You have a duty to tell Us anything that You know, or could reasonably be expected to know, may affect Our decision to insure You and on what terms.

You have this duty until We agree to insure You.
You have the same duty before You renew, extend, vary or reinstate an insurance contract. You do not need to tell Us anything that:

• Reduces the risk We insure You for; or
• Is common knowledge; or
• We know or should know as an insurer; or
• We waive Your duty to tell Us about.

If You do not tell Us something
If You do not tell Us anything You are required to, We may cancel Your contract or reduce the amount We will pay You if You make a claim, or both.

If Your failure to tell Us is fraudulent, We may refuse to pay a claim and treat the contract as if it never existed.

PRIVACY STATEMENT
Batch value the privacy of Your personal information and We will ensure the handling of Your personal information is dealt with in accordance with the Privacy Act 1988 (Cth) and the relevant Australian Privacy Principals. Our full privacy policy can be accessed from Our website www.batchunderwriting.com.

When We provide insurance products and/or services, We ask you for the personal information We need to assess applications for insurance policies, to administer and manage insurance policies and to investigate and handle claims.

This can include a broad range of information ranging from Your name, date of birth, address and contact details to other information about Your personal affairs including Your profession, financial affairs including financial statements, any criminal convictions or claims.
We may need to disclose personal information that You provide us to contractors, coinsureds, insurers and underwriters (who may be located overseas), lawyers, claims adjusters and others engaged by Batch to enable them to administer policies or handle claims. Regardless of the information shared, We will take all reasonable steps to ensure that the above
parties protect Your information in the same way that We do. Our Privacy Policy shown in the above link contains information about how You can access the information We hold about
You, ask us to correct it, or make a privacy related complaint.

BATCH CORPORATE TRAVEL INSURANCE PROPOSAL FORM
If You choose not to provide Your personal information and/or choose not to consent and/or withdraw Your consent to the disclosure of Your personal information to overseas entities at any stage, We may not be able to assess Your application or administer and manage Your insurance Policy and respond to any claim that You make.

Our privacy policies contain information on how You may access personal information that each of us hold, or seek correction of Your personal information and information on how to make a complaint about the handling of Your personal information and how complaints are handled. If You require more information, You can access certain underwriters at Lloyd’s Privacy Notice at https://www.lloyds.com/help/privacy and Batch’s Privacy Policy at batchunderwriting.com.

PRIVACY
I/We agree that, by submitting this form, the personal information I/we provide to Batch Underwriting Pty Ltd in this form or otherwise may be collected, held, used and disclosed in the manner set out in the Batch Privacy Policy found at batchunderwriting.com, including for the processing of this PROPOSAL and providing me/us with cover.

GENERAL INSURANCE CODE OF PRACTICE
Batch Underwriting Pty Ltd proudly support the General Insurance Code of Practice (the ‘Code’). The purpose of the Code is to raise the standards of practice and service in the general insurance industry. For further information on the Code, please visit www.codeofpractice.com.au.

RENEWAL PROCEDURE
Before this policy expires we will normally offer renewal by sending a renewal invitation advising the amount payable to renew this policy. It is important that you check the information shown before renewing each year to satisfy yourself that the details are correct.

DECLARATION
I/WE HEREBY DECLARE AND WARRANT that the answers given above are in every respect true and correct, and that I/We have not withheld any information within My/Our knowledge likely to affect the decision of the Company as to My/Our eligibility for Insurance. This PROPOSAL and declaration shall be the basis of the contract between the Company and Myself/Ourselves and I/We agree to accept the Company’s Policy subject to the terms and conditions to be contained therein.

I declare that:

(a) I have read and understood the Important Notices set out in the Proposal.
(b) I am authorised to complete and sign this declaration on behalf of all the applicants.
(c) I confirm that the answers and statements in this Proposal are true and correct and I have not withheld any information which may affect the decision to accept this Proposal or the terms and conditions of any insurance provided.

(d) I understand that if this Proposal is accepted, the insurance cover will be subject to the terms and conditions set out in the Policy.
(e) I acknowledge that the particulars and statements contained in this Proposal shall form the basis of the contract should a Policy be issued.
(f) I further acknowledge that Batch on behalf of the Insurer(s) may decline this Proposal.
(g) I consent to Batch and the Insurer(s) collecting, storing, using and disclosing personal information as set out in the Privacy Statement. Where I have provided personal information on behalf of another person, I have complied with my obligations as set out in the Privacy Statement.
(h) I understand that this insurance does not operate until Batch issues the Policy Schedule and the Premium has been paid (except for any cover provided under an interim contract of insurance).
Name*

Full NameTitle
Signature*

Clear
Date*

DayMonthYear
Date
Note: All people are costed the same to include 'PARTICIPATING IN TRAINING & COMPETING'.

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 'bind your policy' (it will start) and create the rest of documents (invoice / certificate of currency etc). You will have a short period to pay the invoice, all payment details will be listed on the invoice.

Payment Methods: Wait for the Broker / Insurer invoice to make payment (options apply).

This form will be sent to: Martial Arts Australia Insurance Services
You can discuss details via Email: gslater@martialartsinsurance.com.au
Or - P: 03 8201 9908 URGENT: 0451 331 958 (Text 24/7)
Should be Empty:

MARTIAL ARTS TRAVEL INSURANCE - Quote Application