- Entertainment Equipment -

Entertainment Equipment Insurance Proposal

Please click here for important information on The Entertainment Equipment Insurance Proposal

Where did you hear about Action Entertainment Insurance?

Insured name *

ABN #

Contact Person *

Postal Address *

Postcode *

Phone number *

Fax number

Email address *

Where do you usually store the equipment? *

Period of Insurance

From Date

To Date (4.00PM)

Have you suffered any losses of equipment including theft, fire or damage (whether insured or not) in the last 5 years?

If yes, please provide details

Have you previously been refused insurance or have had your insurance cancelled by an Insurer or have had special conditions, increased premiums or increased excesses imposed on any policy of insurance by an Insurer?

If yes, please provide details

Which type of cover do you required?

Please select World wide (excl.certain countries as specified in the policy wording)
Premises Only-Address

Please advise names of interested parties (eg. finance companies etc)?

SCHEDULE OF ITEMS TO INSURE (please attach a schedule if insufficient space)

NOTE THAT ONLY ITEMS APPEARRING ON THE SCHEDULE ARE COVERED UNDER THE POLICY

Item 1 (Description - Make, Model, Serial No):

Sum Insured

Item 2 (Description - Make, Model, Serial No):

Sum Insured

Item 3 (Description - Make, Model, Serial No):

Sum Insured

Item 4 (Description - Make, Model, Serial No):

Sum Insured

Item 5 (Description - Make, Model, Serial No):

Sum Insured

Item 6 (Description - Make, Model, Serial No):

Sum Insured

Item 7 (Description - Make, Model, Serial No):

Sum Insured

Item 8 (Description - Make, Model, Serial No):

Sum Insured

9. Limit for miscellaneous items (leads, stands, pedals etc.)

10. Limit for hired or borrowed equipment

TOTAL *

Extra Schedule

Addional Info:

Declaration

I/We hereby agree that this proposal & declaration shall be the basis of the contract between myself/ourselves & the Underwriting Insurance Company I/We have chosen. I/We also acknowledge having read & understood the Important Notices forming part of this application.

I/We agree: * Yes No

Type the characters you see in the picture below

Form Menu