Tuesday, 07 February 2012
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Cancellation and Abandonment Insurance

  1. **PLEASE CLICK HERE TO READ IMPORTANT INFORMATION ON THE CANCELLATION & ABANDONMENT INSURANCE QUESTIONNAIRE

    (Note: this will open up a new tab in your browser)

  2. 1. GENERAL INSURANCE INFORMATION REQUIRED

  3. Client Name(*)
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  4. Postal Address(*)
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  5. Suburb(*)
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  6. State(*)
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  7. Postcode(*)
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  8. Contact Person(*)
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  9. Phone Number(*)
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  10. Fax Number
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  11. Email Address(*)
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  1. Business activities of the Proposer (please describe your activities in as much details as possible)(*)
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  2. Period that cover is required for(*)
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  3. Period Date From:
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  4. Period Date To:
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  5. If you require cover for all events during annual period, please provide a schedule of events, dates and locations to be insured

  6. Event
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  7. Date
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  8. Location
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  9. Event
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  10. Date
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  11. Location
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  12. Event
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  13. Date
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  14. Location
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  15. Event
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  16. Date
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  17. Location
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  18. If insufficient space, please provide a separate schedule
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  19. If you only require cover for a ‘one-off’ event, please provide location of where the event will take place?
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  20. Is the event/s being held outdoors?
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  1. 2. IF 'YES'(EVENT/S BEING HELD OUTDOORS) AND COVER IS REQUIRED FOR CANCELLATION DUE TO ADVERSE WEATHER, PLEASE COMPLETE THE FOLLOWING QUESTIONS.

  2. Please specify what type of weather conditions would affect your event/s:
  3. Heavy Rain
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  4. Light Rain
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  5. Lightning
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  6. High Winds
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  7. Are all performers and equipment under cover?
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  8. If 'YES' , please describe the construction of stage and coverage:
  9. Walls
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  10. Floors
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  11. Roof
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  12. Is the event location closed to a water course?
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  13. Does the financial success of the event rely on ticket sales?
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  14. Please note that a CANCELLATION/ABANDONMENT policy DOES NOT cover financial losses resulting form inadequate ticket sales or shortfall in attendance.

  15. Does the financial success of the event rely on ticket sales?
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  16. Please advise estimate number of tickets sales
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  17. How many tickets will be sold prior to the day of the event
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  18. How many tickets will be sold on the day of the event?
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  19. Estimated ticket price
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  20. Do you believe that rain could affect the expected attendance?
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  21. If yes, do you require cover for a financial loss resulting from a shortfall in attendance caused by rain?
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  22. If 'YES' then we would recommend that you consider taking out a PLUVIUS INSURANCE policy in addition to the CANCELLATION/ABANDONMENT policy. A PLUVIUS insurance policy will cover financial losses resulting from a certain limit of rain falling within an agreed time period.
  23. Would you like a separate quotation on PLUVIUS INSURANCE?
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  1. 3. PLEASE COMPLETE THIS SECTION IF COVER IS REQUIRED FOR CANCELLATION OF THE EVENT DUE TO THE NON-APPEARANCE OF THE ARTIST / PERFORMER

  2. Name of artist or performer
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  3. Names and ages of members whose non-appearance would cause cancellation:
  4. First & Last Name (1)
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  5. Date of Birth (1)
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  6. First & Last Name (2)
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  7. Date of Birth (2)
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  8. First & Last Name (3)
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  9. Date of Birth (3)
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  10. First & Last Name (4)
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  11. Date of Birth (4)
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  12. If insufficient space, please provide a separate schedule
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  13. Date of Arrival
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  14. Have you made any allowances for travel delay?
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  15. If yes, please advise
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  16. Is the performer / artist currently in good health?
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  17. If no, please advise
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  18. Note – a medical certificate is required proving the artist / performer is in good health and fit to perform.
  19. Does the artist / performers have any pre-existing medical conditions?
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  20. If yes, please advise?
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  21. Are you aware of any previous cancellations or non-appearance by this artist / performer?
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  22. If yes, please provide details of previous cancellations
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  23. Have all the necessary documents, passports and visas been obtained to allow this artist / performer in to Australia?
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  24. If no, please advise when such documents will be obtained?
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  25. Do you require an extension to cover non-appearance of the artist(s) or performer(s) as a result of death, accident or illness of any of the artists(s) or performers(s) family members?
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  26. Note: This extension may incur additional premium and cover only applies on the death, accident or illness of family members (as defined in the policy) under the age of 70 years.
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  1. 4. SUM INSURED (Note: Must represent the total value at risk – underinsurance condition applies to this insurance)

  2. Expected gross revenue from ticket sales, food & beverages, merchandise, sponsorship and/or guarantees or other sources? $(*)
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  3. Please specify your total costs / expenses for staging this event/s? $ (please provide a schedule of costs/expenses)(*)
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  4. Do you wish to insure against:(*)
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  5. Note: Should you choose to insure for costs/expenses only, you will not be insured for loss of net profit.
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  1. 5. OTHER GENERAL INFORMATION REQUIRED

  2. Have you or any other party to this insurance, suffered a loss or insurance claim under a policy this type?
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  3. If yes, please advise details?
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  4. Have you or any other party to the insurance, ever been refused insurance or had a policy declined by an Insurer, or had the Insurer impose special terms, conditions or excesses on a policy of this type?
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  5. If yes, please provide details?
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  6. Have all the necessary documents, approvals and permission been obtained to stage this event/s?
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  7. Are you aware of any factor that may cause a claim under this insurance?
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  8. If yes, please provide details?
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  1. 6. OTHER INSURANCES We recommend the following other insurances and ask that you contact our office if you would like further information on any of these including quotations:-

  2. PUBLIC LIABILITY INSURANCE FOR SPECIAL EVENTS, CONCERTS ETC.
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  3. VOLUNTARY WORKERS ACCIDENT INSURANCE
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  4. WORKERS COMPENSATION (COMPULSORY FOR ALL EMPLOYERS)
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  5. MONEY
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  6. BUSINESS EQUIPMENT (INCLUDING HIRED OR BORROWED ITEMS)
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  7. PROFESSIONAL INDEMNITY FOR EVENT ORGANISERS
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  8. PLUVIUS INSURANCE
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  9. Additional Info
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  10. DECLARATION : I/We hereby declare that the information provided by me/we in this questionnaire is true and correct and that I/we have read and understand the Important Notices at the start of this questionnaire. I/We also agree that this questionnaire can be used as the proposal of insurance and therefore the basis of the contract of insurance between me/we and the underwriter, if so approved by the underwriter. In submitting this form, I acknowledge that I may receive documentation from Action Insurance Brokers P/L by email. I further agree that Action Insurance Brokers P/L may from time to time send me important information about new insurance products and services.
  11. I/We agree:
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  13. Submit