Cancellation & Abandonment Insurance Questionnaire

Please click here to read important information on The Cancellation and Abandonment Insurance Questionnaire

1. GENERAL INFORMATION REQUIRED

Client name *

Postal address *

Contact Person *

Phone Number *

Fax number

Email address *

Business activities of the Proposer (please describe your activities in as much details as possible) *

Name of Event to be insured *

Period that cover is required for:

Annual period Dates From

Short term period Dates From

If you require cover for all events during annual period, please provide a schedule of events, dates and locations to be insured?

1- Event

1- Date

1- Location

2- Event

2- Date

2- Location

3- Event

3- Date

3- Location

(If insufficient space, please provide a separate schedule)

If you only require cover for a ‘one-off’ event, please provide location of where the event will take place?

Is the event/s being held outdoors?

2. IF YES AND COVER IS REQUIRED FOR CANCELLATION DUE TO ADVERSE WEATHER, PLEASE COMPLETE THE FOLLOWING QUESTIONS.

Please specify what type of weather conditions would affect your event/s:

Heavy rain

Light rain

Lightning

High winds

Are all performers and equipment under cover?

If yes, please describe the construction of stage and coverage?

Walls

Floors

Roof

Is the event location closed to a water course?

Does the financial success of the event rely on ticket sales?

Please note that a CANCELLATION/ABANDONMENT policy DOES NOT cover financial losses resulting form inadequate ticket sales or shortfall in attendance.

Please advise estimate number of tickets sales

How many tickets will be sold prior to the day of the event

How many tickets will be sold on the day of the event

Estimated ticket price

Do you believe that rain could affect the expected attendance?

If yes, do you require cover for a financial loss resulting from a shortfall in attendance caused by rain?

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.

Would you like a separate quotation on PLUVIUS INSURANCE?

3. PLEASE COMPLETE THIS SECTION IF COVER IS REQUIRED FOR CANCELLATION OF THE EVENT DUE TO THE NON-APPEARANCE OF THE ARTIST / PERFORMER

Name of artist or performer

Names and ages of members whose non-appearance would cause cancellation:

1- Name

1- Date of birth

2- Name

2- Date of birth

3- Name

3- Date of birth

4- Name

4- Date of birth

5- Name

5- Date of birth

(If insufficient space, please provide a separate schedule)

Date of arrival?

Have you made any allowances for travel delay?

If yes, please advise

Is the performer / artist currently in good health?

If no, please advise

Note – a medical certificate is required proving the artist / performer is in
good health and fit to perform.

Does the artist / performers have any pre-existing medical conditions?

If yes, please advise?

Are you aware of any previous cancellations or non-appearance by this artist / performer?

If yes, please provide details of previous cancellations?

Have all the necessary documents, passports and visas been obtained to allow this artist / performer in to Australia?

If no, please advise when such documents will be obtained?

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?

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.

4. SUM INSURED

(must represent the total value at risk – underinsurance condition applies to this insurance)

Expected gross revenue from ticket sales, food & beverages, merchandise, sponsorship and/or guarantees or other sources? $ *

Please specify your total costs / expenses for staging this event/s? $ (please provide a schedule of costs/expenses) *

Do you wish to insure against the loss of GROSS REVENUE (i.e. costs/expenses plus net profit) OR COSTS/EXPENSES (i.e. breakeven) only? *

Note: Should you choose to insure for costs/expenses only, you will not be insured for loss of net profit.

5. GENERAL INFORMATION REQUIRED

Have you or any other party to this insurance, suffered a loss or insurance claim under a policy this type?

If yes, please advise details?

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?

If yes, please provide details?

Have all the necessary documents, approvals and permission been obtained to stage this event/s?

Are you aware of any factor that may cause a claim under this insurance?

If yes, please provide details?

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:-

PUBLIC LIABILITY INSURANCE FOR SPECIAL EVENTS, CONCERTS ETC.

VOLUNTARY WORKERS ACCIDENT INSURANCE

WORKERS COMPENSATION (COMPULSORY FOR ALL EMPLOYERS)

MONEY

BUSINESS EQUIPMENT (INCLUDING HIRED OR BORROWED ITEMS)

PROFESSIONAL INDEMNITY FOR EVENT ORGANISERS

PLUVIUS INSURANCE

Additional Info

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.

I/We agree: * Yes No

Type the characters you see in the picture below

Form Menu