Public Liability Insurance - Dance Teachers

   If you need advice, call us on 1300 881 779

Number of Teachers **




4 or more - Call our office or fill the form below

Proceed with Cover...

Visa    MasterCard

Cardholders Name

Credit Card No.

Select Expiration Date:
   

We will email you a receipted tax invoice and "Certificate of Currency".

NOTE: Processing is only done through business hours. Cover is not in place until this form is received and accepted by our office.

Insured Details...

If you have spoken to someone in our office, please note their name here so that this form can be processed by them as they will know something about you already.

Brokers Name: 

Insured Name:

Trading Name:


ABN No.(if applicable):

Full Address:

Email Address:


Website Address (if applicable):


Telephone No:


Business start date:

Professional Duties...Dance Teachers

Please provide full details of the type of Dance Teaching you do:

 

Contractors

Do you employ contractors, sub-contractors?

Yes    No

Your History

Have you (or any person receiving cover under this policy) ever:
  • Had insurance cancelled or declined by an Insurer?
  • Had a proposal rejected, renewal refused or claim rejected by an Insurer?
  • Had any special conditions imposed?
  • Suffered a loss whether insured or not (last 5 years only)?
  • Been involved in a company that has declared bankruptcy or became insolvent?
  • Been charged or convicted for any criminal offence?

Yes    No

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Declaration...
By submitting this Declaration, the Applicant acknowledges:
  • they are authorised by each of the other Applicants to make this Declaration,
  • the contents of the Declaration are true and complete,
  • they are under a continuing obligation to immediately inform QBE of any change in the particulars or statements contained in this Declaration or in the accompanying documents up until the contract is entered into,
  • that no cover is in place until this form is accepted by the insurer

Name of person making this declaration:



Duty of Disclosure - What you must tell us
Under the Insurance Contracts Act 1984 (the Act), you have a Duty of Disclosure. You are required before you enter into, renew, vary, extend or reinstate your Policy, to tell us everything you know and that a reasonable person in the circumstances could be expected to know, is a matter that is relevant to our decision whether to insure you, and anyone else to be insured under the Policy, and if so, on what terms.
  • You do not have to tell us about any matter
  • that diminishes the risk
  • that is of common knowledge
  • that we know or should know in the ordinary course of our business as an insurer, or
  • which we indicate we do not want to know.
  • If you do not tell us
If you do not comply with your Duty of Disclosure we may reduce or refuse to pay a claim or cancel your Policy. If your non-disclosure is fraudulent we may treat this Policy as never having worked.