- Voluntary & Group -

Voluntary & Group Accident Insurance Questionnaire

Please click here to read important information on the Voluntary and Group Accident Insurance proposal

Where did you hear about Action Entertainment Insurance?

Insured name *

Contact Person *

ABN #

Postal address *

Post code *

Phone number *

Fax number

Email address *

Period that cover is required for:

From

To 4:00pm

Your Business Description *

How many voluntary workers or persons will you be engaging to work for you? *

Please advise age ranges (approx) of these persons:

Youngest *

Oldest *

What activities or duties will these persons be conducting? *

Will these persons be engaged in any of the following:

Lifting heavy equipment

Working from heights

If yes, please advise max height

Sporting activities

If yes, what type of sport

Acrobatic, aerial or trapeze

Dangerous or hazardous work

If yes, please describe

Driving vehicles

Will you be paying these persons to work for you?

If yes, please be aware that you might be required to arrange a workers compensation policy to cover these persons. Workers Compensation Insurance is compulsory for all employers. Please contact Action Insurance Brokers if you require further information on Workers Compensation Insurance.

Have you suffered any claims or incidents where persons working for you have been injured?

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

Benefits to Be Insured (see above) *

Addional Info

I/We declare all information given to be correct * Yes No

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Voluntary & Group Accident Insurance Questionnaire

Please click here to read important information on the Voluntary and Group Accident Insurance proposal