Perform-Sure Proposal Form

Please click here to read impotant information on the Perform-Sure Proposal

1. Details Of Perform-Sure Proposal

Name of performing group *

ABN

Contact person *

Postal address *

State *

Post Code *

Phone number *

Fax number

Email address *

Please describe your activities in as much detail *

How many performers in your group? (Please note injuries to PAYG employees are excluded under this insurance). *

Period that cover is required for:

From :

To: 15th July (select year)

Limit of Cover

Estimated annual income (turnover): $ *

Do you use contractors / sub-contractors?

Do you intend to hire out a performance venue to self-promote or stage your own performance?

Will you be signing any contracts that contain hold harmless or indemnity agreements?

Have you suffered any public liability claims or have caused incidents that could give rise to a public liability claim?

If yes, please provide details

Have you ever been convicted of a criminal offence?

Will your performances activities include:

Audience participation with use of fire, sporting, hazardous or dangerous activities ?

Fireworks or pyrotechnics?

Use of animals?

Use of fire?

Use of amusement rides or devices?

Running of workshops?

Any activities conducted outside of Australia/New Zealand?

Additional Info

I/We hereby declare that the information provided by me/we in this proposal form 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

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Perform-Sure Proposal Form

Please click here to read impotant information on the Perform-Sure Proposal

1. Details Of Perform-Sure Proposal