Skip to content
  • Home
  • Latest news
  • Forms and Wordings
    • Insurance Quotation Request
    • Policy and Product Disclosure Statements
    • Financial Services Guide
    • Target Market Determination (TMD)
  • NFP Resources
Community Underwriting
  • Home
  • About us
  • Who we insure
  • Products
    • General Liability Insurance
    • Property Insurance
    • Commercial Motor Vehicle Insurance
    • Voluntary Workers Personal Accident Insurance
    • Association Liability Insurance
    • P&C Insurance Package
  • Claims
  • Latest news
  • NFP Resources
  • Forms and Wordings
  • Contact
  • Request a quote
×
  • Home
  • About us
  • Who we insure
  • Products
    • General Liability Insurance
    • Property Insurance
    • Commercial Motor Vehicle Insurance
    • Voluntary Workers Personal Accident Insurance
    • Association Liability Insurance
    • P&C Insurance Package
  • Claims
  • Latest news
  • NFP Resources
  • Forms and Wordings
  • Contact
  • Request a quote

Step 1 of 4 - Your Details

25%

Your details

Full name of all groups, which are to be covered by your policy
Registered Address
City
State
Post code
Do you consent to receiving communication by email?(Required)
Type of organisation

Are you currently insured?(Required)
DD slash MM slash YYYY
Are you registered for GST?
Name of any Interested Parties e.g. Mortgagee/Lessee:

Are you stamp duty exempt?

To exclude stamp duty from your quotation you will need to provide copies of a current exemption
Drop files here or
Accepted file types: pdf, jpg, jpeg, png, gif, Max. file size: 3 MB, Max. files: 1.
    NSW Charity Exemption (3 year)
    NSW Small Business Exemption (1 year)
    QLD Charity Exemption (ongoing)
    Tasmania (general liability exemption)

    General Questionnaire

    Has any insurer declined an application from you, or cancelled or refused to renew a policy of yours, required special terms to insure you, or declined or refused a claim?(Required)
    Has the organisation had any claims or circumstances which could give rise to a claim in the last 5 years for ANY of the insurances that a quotation is being requested?(Required)
    Have you, or any person who will receive insurance protection under the proposed policy, been charged with, or convicted of, any criminal offences in the past 10 years?(Required)
    During the last 5 years have you, or any other person to whom cover extends under this policy received any threats to life or property (private or business)?(Required)
    Are there any other relevant facts relating to the risk to be insured which you should disclose to us, to enable a true assessment of your insurance Application?(Required)

    Policies

    What cover would you like to apply for?

    GENERAL LIABILITY (Public and Products Liability)

    Please complete if you are applying for this cover
    What level of cover do you require?(Required)

    Number of Employees

    Full time (Required)
    Part time (Required)
    No. of volunteers (including the Board) (Required)

    Estimated number in the congregation
    Estimated number of members

    Hidden

    Estimated Annual Income from all Sources:

    Estimated Annual Income from all Sources:
    Current Year (latest ACNC Financials)
    Estimated for Next 12 Months
    Government
    Current Year (latest ACNC Financials)
    Estimated for Next 12 Months
    Fundraising
    Current Year (latest ACNC Financials)
    Estimated for Next 12 Months
    Donations
    Current Year (latest ACNC Financials)
    Estimated for Next 12 Months
    Other - Current Year (latest ACNC Financials)
    Estimated for Next 12 Months
    Total
    Total - Current Year (latest ACNC Financials)
    Total - Estimated for Next 12 Months

    Please provide a percentage breakdown of your income in the last 12 months


    As an organisation, do you maintain a record of incidents/events that may give rise to a claim against the organisation?
    Does the organisation have a risk register and formal risk management policies and procedures?
    Do you have a volunteer register?

    Premises – Number of premises utilised by your group

    Childcare

    Does your organisation care for children?
    Are parents present at the location when care is provided?
    Do the premises comply with Government legislation?
    Is your childcare operation accredited through the Australian Children’s Education and Care Quality Control (ACECQA)?

    Respite or Similar Care

    Does your organisation provide respite or similar care?
    Do you engage any medically qualified doctors or other Medical Professionals in the provision of services to clients?
    Do you engage nurses or other qualified health or ancillary health professionals in the provision of services to clients?
    Are they independently insured for these activities?
    Do your employees or volunteers administer drugs or medicines of any kind?
    Do people you care for stay overnight in your facility?

    Transportation

    Does your organisation provide transportation of clients as part of your activities?
    Where employee or volunteer vehicles are used to transport clients do you ensure that the employee / volunteer is properly licensed, has a vehicle in safe working condition with fully comprehensive insurance?

    Adult/Youth Accomodation

    Do you provide either or both of the following accommodation

    Adult/Youth Accommodation Questionnaire

    5) Is there a live-in carer on-site?
    6) Do the premises comply with all Government legislation that pertain to your activities?
    7) Do you have a current and tested emergency management plan?
    9) Provide details of each location (not required if already completed for the business package section):
    Location 1 Address
    Construction: Walls
    Floor
    Roof
    10) Fire protection
    11) Security protection
    + Add a 2nd location?
    Location 2 details
    Location 2 Address
    Construction: Walls
    Floor
    Roof
    Fire protection
    Security protection
    + Add a 3rd location?
    Location 3 details
    Location 3 Address
    Construction: Walls
    Floor
    Roof
    Fire protection
    Security protection
    End questionnaire

    Home visits

    Do you conduct Home Visits?

    Social or Recreational Activities

    Does your organisation arrange or participate in any social or recreational activities?
    Activity
    Duration
    No. During the Year
    No. of People Attending
    Locations
    Activity - Walks
    Duration
    No. During the Year
    No. of People Attending
    Locations
    Activity - Non-contact sports
    Duration
    No. During the Year
    No. of People Attending
    Locations
    Activity - Contact sports
    Duration
    No. During the Year
    No. of People Attending
    Locations
    Activity - Market stalls organised by you
    Duration
    No. During the Year
    No. of People Attending
    Locations
    Activity - Market stalls organised by other parties
    Duration
    No. During the Year
    No. of People Attending
    Locations
    Activity - Boat trips
    Duration
    No. During the Year
    No. of People Attending
    Locations
    Activity - Fun runs, cycling events
    Duration
    No. During the Year
    No. of People Attending
    Locations
    Activity - Other
    Activity (Required)
    Duration (Required)
    No. During the Year (Required)
    No. of People Attending (Required)
    Locations (Required)
    Is alcohol allowed or supplied at any of the above activities?

    Alcohol Questionnaire

    Where alcohol will be served, we require some additional details to determine if we can provide cover under the Community Underwriting General Liability policy:

    1) Function held on third party commercially licensed premises

    a. The third-party organisation holds a liquor license?
    b. The third-party is responsible for all aspects of the supply of alcohol including responsible service of alcohol, under aged attendees and alcohol impaired attendees?

    2) Private function where you will be serving, supplying or selling alcohol to invited guests:

    a. Will you obtain a liquor license?
    b. Has any liquor license ever been suspended or revoked?
    c. Are under aged people invited to the event?
    d. Are volunteers / staff / contractors trained in the responsible service of alcohol?

    3) Open event where you will be serving, supplying or selling alcohol to attendees:

    a. Will you obtain a liquor license?
    b. Has any liquor license ever been suspended or revoked?
    c. Are attendees allowed to bring alcohol to the event?
    d. Are under aged people invited to the event?
    e. Are volunteers / staff / contractors trained in the responsible service of alcohol?
    End questionnaire
    Hidden

    Premises

    Are any of your premises used by other third parties?
    Please confirm the following
    Does your organisation organise, promote or co-ordinate any event held outdoors; at your premises with more than 100 attendees; or at third party commercial premises with more than 500 attendees?

    Events Questionnaire

    DD slash MM slash YYYY
    Address
    Will there be alcohol at the event?

    Please complete the Alcohol questionnaire further down the page after completing all remaining questions in Events questionnaire

    Will there be any mechanical and/or animal rides present?
    Will there be any market stalls present?
    Will there be any entertainment?
    Will there be a dance floor?
    Will there be a mosh-pit?
    Will there be any temporary staging and/or seating structures erected?
    Will there be any fireworks?
    Will there be trained first aid personnel present?
    Will Police be present?
    Will First Aid Personnel be present?
    Will there be security personnel present?
    Will they be:
    Has a risk assessment report been done of the entire event?
    Drop files here or
    Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 2 MB, Max. files: 1.
      If no risk assessment report has been done, will one be done closer to the event?
      Will there be any waterborne activities?
      Do all vendors/exhibitors, amusement operators, performers, contractors and all other service providers require to carry their own Liability insurance?
      Will they note your organisation as principal on their insurance?
      End Events questionnaire

      Events Alcohol Questionnaire

      Where alcohol will be served, we require some additional details to determine if we can provide cover under the Community Underwriting General Liability policy:

      1) Function held on third party commercially licensed premises

      a. The third-party organisation holds a liquor license?
      b. The third-party is responsible for all aspects of the supply of alcohol including responsible service of alcohol, under aged attendees and alcohol impaired attendees?

      2) Private function where you will be serving, supplying or selling alcohol to invited guests:

      a. Will you obtain a liquor license?
      b. Has any liquor license ever been suspended or revoked?
      c. Are under aged people invited to the event?
      d. Are volunteers / staff / contractors trained in the responsible service of alcohol?

      3) Open event where you will be serving, supplying or selling alcohol to attendees:

      a. Will you obtain a liquor license?
      b. Has any liquor license ever been suspended or revoked?
      c. Are attendees allowed to bring alcohol to the event?
      d. Are under aged people invited to the event?
      e. Are volunteers / staff / contractors trained in the responsible service of alcohol?
      f. How will alcohol impaired attendees be managed?
      End Events Alcohol questionnaire
      Hidden

      Does your organisation organise, promote or co-ordinate any camps?

      Camping Facilities Questionnaire

      If your organisation organises, promotes or co-ordinates any camps, we require some additional details on the type of camp arrangements and activities to determine if we can provide cover under the Community Underwriting General Liability policy:

      General Information

      d) Is a risk assessment undertaken for the camp to identify hazards and potential exposures?
      e) Do all campers / parents of attending children sign permission and waiver documentation?
      f) Are written instructions from parents required prior to administering medication to minors?

      Camps at third party commercially operated venues

      a) Will there be camps at third party operated venues?
      The third-party organisation provides accommodation, organises and is responsible for all camp activities (and is separately insured for this)

      Camps at third party venues or in camp sites approved by a State or National Park Authority

      Will the camps be at third party venues or in camp sites approved by a State or National Park Authority
      d) Are animals on the camp site?

      Camps in open bushland (We are unable to provide cover for these activities)

      Will the camps be in open bushland (We are unable to provide cover for these activities)
      End questionnaire

      Does the organisation engage in any of the following higher hazard activities?

      Abseiling
      Run and insured by external provider
      Archery
      Run and insured by external provider
      Caving
      Run and insured by external provider
      Flying fox / zip lines
      Run and insured by external provider
      Horse riding / equestrian
      Run and insured by external provider
      Jet skiing
      Run and insured by external provider
      Other use of watercraft
      Run and insured by external provider
      Martial Arts
      Run and insured by external provider
      Motor bike rides
      Run and insured by external provider
      Outdoor rock climbing
      Run and insured by external provider
      Paintball / skirmish
      Run and insured by external provider
      Rope courses, tug-of-war
      Run and insured by external provider
      Shooting
      Run and insured by external provider
      Skate boarding
      Run and insured by external provider
      Snorkelling, diving, surfing
      Run and insured by external provider
      Other
      Run and insured by external provider
      Activity
      Does the organisation use a swimming pool or conduct water-based activities?
      Own Pool(Required)
      Ratio of teacher to participants in compliance with Austswim guidelines(Required)
      Water safety supervision in compliance with Austswim guidelines(Required)
      Signage and fencing compliant with government requirements(Required)
      Third party or public pool(Required)
      Ratio of teacher to participants in compliance with Austswim guidelines(Required)
      Water safety supervision in compliance with Austswim guidelines(Required)
      Inland waterways (lake, dam, lagoon, river, creek or stream)(Required)
      Ratio of teacher to participants in compliance with Austswim guidelines(Required)
      Water safety supervision in compliance with Austswim guidelines(Required)
      Open waterways (beach, ocean, harbour)(Required)
      Ratio of teacher to participants in compliance with Austswim guidelines(Required)
      Water safety supervision in compliance with Austswim guidelines(Required)

      Manufacture, Distribution, Sale or Supply of Products

      Are you involved in the manufacture, distribution, sale, supply, maintenance or repair of any products?
      Products list
      Product
      Use
      Manufacturers/Supplier
      Country of Origin
      Est Revenue
       

      Optional Extension

      Molestation / Sexual Abuse (not available for all activities)

      Abuse and Molestation Questionnaire

      1) Do you have a formal written abuse and molestation prevention policy?
      Does the formal policy address for employees, volunteers and contractors:
      (a) a zero tolerance for any abuse or inappropriate behaviour?
      (b) appropriate and inappropriate interaction with children or other vulnerable people in your care
      (c) interactions with children or other vulnerable persons in your care outside of regular program activities (including the use of electronic devices and social media)?
      (d) managing the risk when a single employee/volunteer is alone with a child or other vulnerable person?
      (e) processes for the reporting of abuse or molestation by a victim, employee or volunteer?
      DD slash MM slash YYYY
      DD slash MM slash YYYY
      Are all staff, volunteers and contractors engaged by you have access to and are made aware of the policy?
      Do you provide annual formal training on the policy, including refresher training?
      2) Is the organisation involved in any of the following activities? ( If yes, please indicate the percentage that each would represent):
      a) residential facilities
      b) schools
      c) schools including student accommodation
      d) childcare, private teaching, coaching, tutoring or other education programs utside of schools
      e) clubs and associations involving children
      f) health, counselling and support services
      g) sport and active recreation
      h) child accommodation services, including home stays
      i) churches or religious education / activities
      j) scouts, girl guides or other cadet programs, camps
      k) other activities with children and/or vulnerable clients (please provide details)
      3) Estimated breakdown of services provided to clients by age group:
      0 - 10 years
      11 - 18 years
      19 - 65 years
      65+ years

      Do you require the optional extension for:

      Prior Acts Claims Made Coverage
      Compensation for Temporary Staff Costs
      End questionnaire
      Hidden

      BUSINESS PACKAGE

      Please complete the relevant sections that you are applying for this cover

      Location 1 - Details

      Location 1 - Sums Insured

      Business Property (Fire and specific perils including accidental damage)

      Theft of Property

      (Additional premium applies)

      Location 1 - Property Risk Details

      Construction materials
      Is Expanded Polystyrene (EPS) used in any part of the construction?
      Is the building subject to a heritage or National Trust listing?
      Is the building connected to town water?
      What fire protection is in place?
      What security protection is in place?
      Are there any buildings within 100m of uncleared natural bushland or in a known bushfire exposed area
      Any commercial cooking facilities?

      Kitchen Facilities Questionnaire (Location 1)

      If you have commercial kitchen facilities on your premises, we need additional information to consider your insurance quotation request:
      1) Please describe the type and range of cooking / catering activities undertaken:
      2) Which of the following are used in the kitchen facilities?
      3) Is any cooking, baking or frying undertaken unsupervised or after hours?
      a. Are the deep-frying units thermostatically controlled with an automatic cut off switch?
      b. Are wet chemical suppression systems in place?
      c. Is the oil in each deep-frying unit filtered daily and replaced weekly?
      d. Does the kitchen contain cooking hoods, filters and ducted exhaust system?
      e. Are all extraction hoods, canopies, exhausts, filters and grease traps cleaned regularly?
      f. Are written records kept for the cleaning / maintenance regime?
      g. Are additional wet chemical extinguishers / fire blankets in place?
      5) Are formal housekeeping procedures in place for cleaning of materials from benchtops, skimming of scraps from deep fryers and regular rubbish removal?
      6) For cold storage areas containing expanded polystyrene (EPS) panels, are these facilities:
      a. Kept clear and unobstructed by any combustible materials, packaging, pallets etc?
      b. Inspected regularly for damage which compromises the integrity of the panels?
      c. Adequately fire sealed where there are service penetrations through the panels?
      End questionnaire
      Hidden

      Is the property a church or place of worship?

      Places of Worship Property Questionnaire (Location 1)

      If we are providing coverage for churches and other places of worship, we need additional information to consider your insurance quotation request:
      1) Is the property or parts of the property heritage listed?
      Has a valuation or other professional assessment been undertaken that considers the costs and specialist resources required to repair or restore the building(s) to a reasonably equivalent appearance and functionality?
      DD slash MM slash YYYY
      2) Are the floors, walls or roof of the property decorated in iconography or other architectural or special finishes?
      3) Are there other significant items of religious musical equipment, art, curios, culturally significance included in the contents?
      Have they been individually catalogued?
      Item
      Value $
      4) Does the organisation use candles and/or lamps as part of its religious services and celebrations?
      Please nominate all types in use
      Where other than non-combustible sources are in use, are policies and procedures in place to ensure:
      5) Does the organisation undertake regular inspection and have preventative maintenance programs in place for walls, floor coverings, roofs, gutters, gates and fences, electrical switchboards, plumbing, heating and cooling systems?
      Do they ensure:
      End questionnaire
      Hidden

      + Add a 2nd location

      Location 2 - Details

      Location 2 - Sums Insured

      Business Property (Fire and specific perils including accidental damage)

      Theft of Property

      (Additional premium applies)

      Location 2 - Property Risk Details

      Construction materials
      Is Expanded Polystyrene (EPS) used in any part of the construction?
      Is the building subject to a heritage or National Trust listing?
      Is the building connected to town water?
      What fire protection is in place?
      What security protection is in place?
      Are there any buildings within 100m of uncleared natural bushland or in a known bushfire exposed area
      Any commercial cooking facilities?

      Kitchen Facilities Questionnaire (Location 2)

      If you have commercial kitchen facilities on your premises, we need additional information to consider your insurance quotation request:
      1) Please describe the type and range of cooking / catering activities undertaken:
      2) Which of the following are used in the kitchen facilities?
      3) Is any cooking, baking or frying undertaken unsupervised or after hours?
      a. Are the deep-frying units thermostatically controlled with an automatic cut off switch?
      b. Are wet chemical suppression systems in place?
      c. Is the oil in each deep-frying unit filtered daily and replaced weekly?
      d. Does the kitchen contain cooking hoods, filters and ducted exhaust system?
      e. Are all extraction hoods, canopies, exhausts, filters and grease traps cleaned regularly?
      f. Are written records kept for the cleaning / maintenance regime?
      g. Are additional wet chemical extinguishers / fire blankets in place?
      5) Are formal housekeeping procedures in place for cleaning of materials from benchtops, skimming of scraps from deep fryers and regular rubbish removal?
      6) For cold storage areas containing expanded polystyrene (EPS) panels, are these facilities:
      a. Kept clear and unobstructed by any combustible materials, packaging, pallets etc?
      b. Inspected regularly for damage which compromises the integrity of the panels?
      c. Adequately fire sealed where there are service penetrations through the panels?
      End questionnaire
      Hidden

      Is the property a church or place of worship?

      Places of Worship Property Questionnaire (Location 2)

      If we are providing coverage for churches and other places of worship, we need additional information to consider your insurance quotation request:
      1) Is the property or parts of the property heritage listed?
      Has a valuation or other professional assessment been undertaken that considers the costs and specialist resources required to repair or restore the building(s) to a reasonably equivalent appearance and functionality?
      DD slash MM slash YYYY
      2) Are the floors, walls or roof of the property decorated in iconography or other architectural or special finishes?
      3) Are there other significant items of religious musical equipment, art, curios, culturally significance included in the contents?
      Have they been individually catalogued?
      Item
      Value $
      4) Does the organisation use candles and/or lamps as part of its religious services and celebrations?
      Please nominate all types in use
      Where other than non-combustible sources are in use, are policies and procedures in place to ensure:
      5) Does the organisation undertake regular inspection and have preventative maintenance programs in place for walls, floor coverings, roofs, gutters, gates and fences, electrical switchboards, plumbing, heating and cooling systems?
      Do they ensure:
      End questionnaire
      Hidden

      + Add a 3rd location

      Location 3 - Details

      Location 3 - Sums Insured

      Business Property (Fire and specific perils including accidental damage)

      Theft of Property

      (Additional premium applies)

      Location 3 - Property Risk Details

      Construction materials
      Is Expanded Polystyrene (EPS) used in any part of the construction?
      Is the building subject to a heritage or National Trust listing?
      Is the building connected to town water?
      What fire protection is in place?
      What security protection is in place?
      Are there any buildings within 100m of uncleared natural bushland or in a known bushfire exposed area
      Any commercial cooking facilities?

      Kitchen Facilities Questionnaire (Location 3)

      If you have commercial kitchen facilities on your premises, we need additional information to consider your insurance quotation request:
      1) Please describe the type and range of cooking / catering activities undertaken:
      2) Which of the following are used in the kitchen facilities?
      3) Is any cooking, baking or frying undertaken unsupervised or after hours?
      a. Are the deep-frying units thermostatically controlled with an automatic cut off switch?
      b. Are wet chemical suppression systems in place?
      c. Is the oil in each deep-frying unit filtered daily and replaced weekly?
      d. Does the kitchen contain cooking hoods, filters and ducted exhaust system?
      e. Are all extraction hoods, canopies, exhausts, filters and grease traps cleaned regularly?
      f. Are written records kept for the cleaning / maintenance regime?
      g. Are additional wet chemical extinguishers / fire blankets in place?
      5) Are formal housekeeping procedures in place for cleaning of materials from benchtops, skimming of scraps from deep fryers and regular rubbish removal?
      6) For cold storage areas containing expanded polystyrene (EPS) panels, are these facilities:
      a. Kept clear and unobstructed by any combustible materials, packaging, pallets etc?
      b. Inspected regularly for damage which compromises the integrity of the panels?
      c. Adequately fire sealed where there are service penetrations through the panels?
      End questionnaire
      Hidden

      Is the property a church or place of worship?

      Places of Worship Property Questionnaire (Location 3)

      If we are providing coverage for churches and other places of worship, we need additional information to consider your insurance quotation request:
      1) Is the property or parts of the property heritage listed?
      Has a valuation or other professional assessment been undertaken that considers the costs and specialist resources required to repair or restore the building(s) to a reasonably equivalent appearance and functionality?
      DD slash MM slash YYYY
      2) Are the floors, walls or roof of the property decorated in iconography or other architectural or special finishes?
      3) Are there other significant items of religious musical equipment, art, curios, culturally significance included in the contents?
      Have they been individually catalogued?
      Item
      Value $
      4) Does the organisation use candles and/or lamps as part of its religious services and celebrations?
      Please nominate all types in use
      Where other than non-combustible sources are in use, are policies and procedures in place to ensure:
      5) Does the organisation undertake regular inspection and have preventative maintenance programs in place for walls, floor coverings, roofs, gutters, gates and fences, electrical switchboards, plumbing, heating and cooling systems?
      Do they ensure:
      End questionnaire
      Hidden

      Removal of debris

      Business Interruption

      (months)

      Theft of Money

      Coverage required

      Glass Breakage

      Coverage required

      Machinery, Electrical Equipment, Deterioration of Stock in Cold Storage

      Coverage required

      Machinery Breakdown (including registered pressure vessels)

      Blanket Items of Equipment
      Deterioration of Stock in Cold Storage
      Is a temperature sensing alarm system installed

      Electronic Equipment Breakdown

      Coverage required
      Blanket Items of Equipment
      Increased Cost of Working
      Restoration of Electronic Data / Data Media
      Are all items of equipment in good state of repair and regularly serviced

      General Property (portable items regularly removed from the premises)

      Coverage required

      Goods in Transit within Australia

      Coverage required

      MOTOR VEHICLES

      Please complete if you are applying for this cover

      Motor Vehicles Owned

      Please provide the following details of the organisation’s vehicles

      + Add a 2nd vehicle?
      + Add a 3rd vehicle?
      + Add a 4th vehicle?
      + Add a 5th vehicle?
      + Add a 6th vehicle?
      + Add a 7th vehicle?

      Has any current or intended driver of your vehicle(s):

      a) been fined or convicted of more than 3 speeding or other traffic offence (other than parking) within the last 3 years?
      b) had a driving licence endorsed, suspended or cancelled within the last 5 years?
      c) been convicted with Prescribed Concentration of Alcohol (PCA) or Driving Under the Influence (DUI) in the last 2 years?
      d) suffered from any physical or mental condition which could affect their driving performance?

      Optional Extension for Employees and Volunteers Vehicles (Loss of no claims bonus, excess payment and hire car)

      Coverage required
      Extras

      VOLUNTARY WORKERS PERSONAL ACCIDENT

      Please complete if you are applying for this cover

      Number of volunteers engaged in clerical, administrative, sales, fund raising, managerial, board or similar

      Number of volunteers engaged in client care, transport, domestic, kitchen, general maintenance, gardening or similar

      Number of volunteers engaged in manual handling, construction, animal care, farming, Landcare or similar

      Has any person ever been injured while doing voluntary work for the organisation?(Required)
      Cover required(Required)

      ASSOCIATION LIABILITY

      Please complete if you are applying for this cover
      Required Total Sum Insured

      Directors and Officers cover

      Has any director or executive officer of the Organisation been declared bankrupt or entered into a deed of assignment, composition or a scheme of arrangement with creditors?

      Drop files here or
      Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 2 MB, Max. files: 1.
        As part of this Application please attach the most recent Audited Financial Statements lodged with the ACNC or independently.

        Is there any subsequent information of a material nature not disclosed in the attached financial statements that could affect the financial position, capital structure or operation of the Organisation?

        Professional Indemnity cover

        Please tick Yes or No and give details as requested below. Does the organisation:

        Provide legal, financial, investment or environmental advice? If Yes please complete Financial Advice Questionnaire

        Financial Advice Questionnaire

        3) Do you have an Australian Financial Services Licence or act as an Authorised Representative of any AFS Licence holder?
        4) Has any AFS licence or Authorised Representative arrangement been cancelled or restricted
        5) Do you provide financial advice to clients for a fee?
        Please provide an estimate of the revenue generated from specific services:
        Last Year
        Next Year
        Financial planning / portfolio management
        Financial planning / portfolio management - Last Year
        Financial planning / portfolio management - Next Year
        Life insurance
        Life insurance - Last Year
        Life insurance - Next Year
        Mortgage / finance broking
        Mortgage / finance broking - Last Year
        Mortgage / finance broking - Next Year
        Tax advice, budgeting, refinancing
        Tax advice, budgeting, refinancing - Last Year
        Tax advice, budgeting, refinancing - Next Year
        Microfinance, no interest or low interest loan facility
        Microfinance, no interest or low interest loan facility- Last Year
        Microfinance, no interest or low interest loan facility - Next Year
        Are eligibility reviews, loan assessment and approvals undertaken by a third party finance provider that assumes any credit license exposures and responsibilities?
        6) Do you have a documented risk management and compliance program?
        7) Does the risk management program include regular audits / client reviews?
        End questionnaire
        Hidden

        Engage in any form of medical treatment, medical advice or scientific or medical research?
        Provide any web hosting or act as an internet service provider?
        Provide computer or information services or websites with chat lines or bulletin boards or discussion areas where input can be posted by the public at large?
        Promote or provide any form of insurance to your members or act as insurance agent?
        Engage in the manufacture, sale or distribution of any product or process or patented production process?
        If Yes to any of the above, please provide details on a separate sheet (including the qualifications / experience of persons providing the professional service.

        Employment Practices cover (relevant to the risk exposures from engaging both employees AND volunteers)

        Please state the number of employees in the following salary ranges:

        Did you initiate any termination(s) within the last 2 years?

        Are written policies and procedures in place for employees and/or volunteers regarding the following?

        Equal opportunity
        Anti-sexual harassment
        Discrimination / bullying
        Formal procedures to be followed for performance management, complaints and termination of employment

        Fidelity / Crime cover

        Have you sustained any loss through fraud or dishonesty of any employee?
        Are all cheques / EFT transactions required to be signed by at least two different authorised signatures?
        Do you operate a trust account?
        If Yes is the trust account independently audited?
        Do you employ the services of an independent accountant?
        Are duties segregated so that no individual can control any financial or asset function from commencement to completion?
        Have you ever received a tax audit advice from the Australian Taxation Office?

        Optional Extension

        CyberRisk ($100,000 / $50,000)
        Have you previously suffered a CyberRisk incident
        Removal of insolvency exclusion
        Drop files here or
        Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 4 MB, Max. files: 2.

          Association Liability – Claims and Circumstances

          At any time in the past, has any claim been made against the Association/Organisation or any Office Bearers, Executive Staff, Sub-committee members, employees of the Association/Organisation?(Required)
          Are there any circumstances not already notified to insurers which may give rise to a claim against the Organisation, or any Office Bearer, Executive Staff, Sub-committee members, employee or volunteers of the Organisation?(Required)
          If insurance similar to that now proposed had been, or were now in effect, would any claim which had been made, or which is now pending against the Organisation or any person proposed for insurance, have fallen within the scope of such insurance?(Required)
          Is any person proposed for insurance aware, after enquiry, of any circumstances or incident which he/she believes might give rise to any future claim that would fall within the scope of such insurance?
          Has the Organisation or any person proposed for insurance ever had similar insurance cancelled or declined to renew, or had special terms imposed in relation to this type of insurance?
          where I/we have provided personal information about other individuals, I/we have complied with all relevant obligations under the Privacy Act 1988 (Cth) including the Privacy Amendment (Enhancing Privacy Protection) Act 2012 (see below);

          Declaration

          This Declaration must be completed and signed by all parties applying for insurance or on their behalf by someone authorised to complete and sign this
          Consent(Required)
          • the answers and information given by me/us in this Application are true and correct in all respects and that no material information has been withheld
          • I/we have read and understood the clauses detailed under the Important Notices section of this Application (see subsequent pages of Application form);
          • if there was insufficient space to fully answer any questions, we have attached supplementary pages providing the additional information required;
          • if any information given by me/us alters between the date of this Application form and the inception date of the Insurance to which this application relates, I/we shall give immediate notice of this;
          • I/we authorise Community Underwriting and Insurer(s) to collect or disclose any personal information relating to this insurance to/from any other insurers or insurance reference service;
          • where I/we have provided information about another individual (for example, an employee, or client), I/we declare that the individual has been or will be made aware of that fact;
          • where I/we have provided personal information about other individuals, I/we have complied with all relevant obligations under the Privacy Act 1988 (Cth) including the Privacy Amendment (Enhancing Privacy Protection) Act 2012 (see below);
          • I/we also confirm that the undersigned are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this Application Form. I/we have completed this Application Form on their behalf, after enquiry has been made of all directors and senior staff;
          • I/we confirm that we consent to receive insurance documentation from Community Underwriting by electronic means; and
          • I/we have read and understood the Privacy Act 1988 information and consent to the collection, storage, use and disclosure of personal and sensitive information of all persons covered by the General insurance Application Form. Where personal information has been provided on someone else’s behalf, that person has consented to this provision.
          DD slash MM slash YYYY
          DD slash MM slash YYYY
          It is important the signatory/signatories to the Declaration is/are fully aware of the scope of this insurance so that all questions can be answered. If in doubt, please contact your insurance broker since non-disclosure may affect an insured’s right of recovery under the policy or lead to it being voided.
          Important Notices

          It is important that you read the terms and conditions listed below from Community Underwriting and Insurer(s) collectively referred to in this section as ‘we’, ‘us’ and ‘our’.

          Duty of Disclosure Applicable to Business Package, General Liability and Association Liability Insurance Policies.

          Our policies are subject to the Insurance Contracts Act 1984. Under that Act you have a duty of disclosure. Before you take out insurance with us, you have a duty to tell us of everything that you know, or could reasonably be expected to know, that is relevant to our decision to insure you and to the terms of that insurance. If you are not sure whether something is relevant you should inform us anyway. You have the same duty to inform us of those matters before you renew, extend, vary, or reinstate your contract of insurance.

          Your duty however does not require disclosure of matters that:

          • Reduce the risk
          • Are common knowledge
          • We know or, in the ordinary course of our business, ought to know, or
          • We have indicated we do not want to know.

          If you do not comply with your duty of disclosure, we may be entitled to:

          • Reduce our liability for any claim
          • Cancel the contract
          • Refuse to pay the claim
          • Avoid the contract from its beginning, if your non-disclosure was fraudulent.
          Duty of Disclosure Applicable to Motor Vehicle and Personal Accident Insurance Policies.

          What You Must Tell Us

          When answering our questions, you must be honest and you have a duty under law to tell us anything known to you, and which a reasonable person in the circumstances, would include in the answer to the question. We will use the answers in deciding whether to insure you and anyone else to be insured under the policy, and on what terms.

          Who Needs to Tell Us?

          It is important that you understand you are answering our questions in this way for yourself and anyone else whom you want to be covered by the policy.

          If You Do Not Tell Us

          If you do not answer our questions in this way, we may reduce or refuse to pay a claim, or cancel the policy. If you answer our questions fraudulently, we may refuse to pay a claim and treat this policy as never having been in force.

          Underinsurance

          The Business Package policy is subject to an 80% “Underinsurance” clause. This means that if you have insured items under this policy for less than 80% of their actual value at the time you took out this policy, we will reduce the amount we pay you under this policy in accordance with the following sum:

          Sum Insured x Amount of loss/damage ÷ 80% of value = Amount payable by Insurer(s) (up to the Sum Insured).

          The “Underinsurance” clause applies to the Fire, and the “Gross Income” and Departmental Clause under the Business Interruption Section and Electronic Equipment Sections.

          Our Right of Recovery

          The policies you are applying for contain a provision which states that if you Enter into any contractual arrangement and/or surrender your right to seek recovery from another party for a loss covered by the policy, we have a right to reject any claim from you in relation to that loss.

          GST

          The amount of cover you choose excludes Goods and Services Tax (GST). If you are not registered for GST, in the event of a claim we will reimburse you the GST component in addition to the amount that we pay. The amount that we are liable to pay under this policy will be reduced by the amount of any input tax credit that you are or may be entitled to claim for the supply of goods or services covered by that payment.

          If you are entitled to an input tax credit for the Premium you have paid, you must inform us of the extent of that entitlement at or before the time you make a claim under this policy. We will not indemnify you for any GST liability, fines or penalties that arise from or are attributable to your failure to notify us of your entitlement (or correct entitlement) to an input tax credit on the premium. If you are liable to pay an Excess under this policy, the amount payable will be calculated after deduction of any input tax credit that you are or may be entitled to claim on payment of the Excess.

          If you are unsure about the taxation implications of this policy, you should seek advice from your accountant or tax professional.

          Notices Only Applicable to the Association Liability Policy

          Claims Made and Notified Policy

          The Application as far as it relates to Association Liability Insurance is for a ‘claims made’ policy. This means that the policy covers you for claims made against you during the period of insurance specified in your policy schedule and notified to us during that period of insurance.

          This means that the policy does not provide cover in relation to:

          • Events which occurred prior to the period of insurance or any earlier retroactive date stipulated in the policy schedule;
          • Claims made against you after the expiry of the period of insurance even though the event giving rise to the claim may have occurred during the period of insurance;
          • Claims arising from or attributable to any facts, circumstances or occurrences noted on the Application for the current period of insurance or on any previous or of which notice had been given under any previous policy;
          • Claims arising from or attributable to any facts, circumstances or occurrences of which you were aware and knew (or ought reasonably to have realised) prior to the commencement of the period of insurance may give rise to a claim.

          Section 40(3) of the Insurance Contracts Act 1984 provides that an insurer is not relieved from liability under a contract of insurance in respect of a claim by reason only that the claim was made after the expiry of the period of insurance cover provided by the contract where the insured has.

          Given notice in writing to the insurer:

          • of the facts that might give rise to a claim against the insured;
          • as soon as was reasonably practicable after the insured became aware of those facts, and
          • before the expiry of the period of insurance.

          Retroactive Liability

          The Association Liability insurance may be limited by a retroactive date which will be shown on the schedule. If a retroactive date applies the policy does not cover any claim arising from any actual or alleged act, error, omission or conduct occurring prior to the retroactive date.

          Average Provision

          One of the provisions of the proposed Association Liability insurance provides that where the amount required to dispose of a claim exceeds the limit of indemnity in the policy then the insurer will only be liable only for a proportion of the total costs and expenses. This will be the same proportion of the total costs and expenses as the policy limit bears to the total amount required to dispose of the claim.

          Privacy

          Community Underwriting and Insurer(s) seek at all times to comply with the Privacy Act 1988 and the Australian Privacy Principles therein. If We disclose personal information to you for any reason you must also act in accordance with and comply with the terms of the Privacy Act and the Australian Privacy Principles.

          Purpose for collection of information:

          The information contained in this document and any other documents provided to Us will be dealt with in accordance with our respective Privacy Policies.

          Disclosure of Information that you provide to us:

          Community Underwriting and Insurer(s) will only use the information in accordance with the terms of the Privacy Policies. Without limiting the application of the Policy Community Underwriting and Insurer(s) may disclose personal information to other individuals or organisations in connection with your claim, including legal advisors, other parties, other lawyers, experts and witnesses, courts and tribunals and other organisations that need to be involved in the matter. By submitting your notification and continuing to deal with us you consent to Community Underwriting, Insurer(s) and these parties collecting, using and disclosing personal and sensitive information about you for these purposes. By signing the claim form you are consenting to the above.

          You warrant to us that where you provide us with personal information that you have collected from other individuals:

          • that the information has been collected in accordance with the Privacy Act 1988.
          • that We are authorised to receive that information from you and to use it for the purpose of providing legal claims management services and advice.
          • you, and the person who provided you with the information, are aware and have complied with the Privacy Act 1988 and have notified the person about whom the personal information is collected of the collection use and disclosure of such information.

          By executing the claim form you are indemnifying Community Underwriting and Insurer(s) against any breach that arises directly or indirectly out of any act or omission of your part which does not accord with the conduct required under the Privacy Act 1988.

          Direct Marketing:

          We do not disclose personal information that We collect to a third party for the purpose of allowing them to direct market their products and services unless you have given Us Your permission for Us to do this.

          Cross Border:

          We will share your personal information with the Community Underwriting and the Insurer(s). Our data containing your information is stored in our data centre using dedicated hardware and network. We may also use Saas, Cloud computing or other technologies from time to time and your information may be stored outside Australia. We will not transfer personal information to a recipient in a foreign country unless We have appropriate protections in place as required by the relevant privacy laws. Your information will be stored on our data base for such period of time as required by law.

          Further information

          If you would like further information, please review our full Privacy Policy on our website or if you have any complaints or concerns over the protection of the information you have given to us or that we have collected from others, contact send an email to admin@communityunderwriting.com.au.

          Complaints and Dispute Resolution

          Any enquiry or complaint relating to this insurance should in the first instance be referred to:

          Complaints Manager Community Underwriting Agency Pty Ltd P.O. Box 173, Balmain NSW 2041

          If you think we have let you down in any way, or our service is not what you expect (even if through one of our representatives), please tell us so we can help. We are committed to resolving your complaint fairly.

          We will address all complaints, except where specific circumstances apply, in accordance with Community Underwriting’s Complaints Handling Process. This process is compliant with the Insurance Council of Australia’s Code of Practice. Both the Code of Practice and our Complaints Brochure, which contains a guide to our process, are available upon request.

          If you have a complaint:

          Step 1: On the spot, if we can!

          You can contact us by:

          Phone: +61 2 8045 2580

          Fax: +61 2 9555 1886

          Email: service@communityunderwriting.com.au

          Mail: PO Box 173 Balmain NSW 2041

          • If we can’t resolve your complaint immediately, we will commit to responding to your complaint within 15 business days of first being notified of the complaint.
          • If we need more information or more time to respond properly to your complaint we will contact you to agree an appropriate timeframe to respond.

          Step 2: Internal Dispute Resolution

          • If you are not happy with our response, please tell us in writing. You may escalate it as a dispute and our Internal Dispute Resolution panel (the panel) will review the matter. The panel will be independent of the person who initially considered your complaint.
          • The Disputes Resolution Officer will acknowledge your dispute in writing within 2 business days of receipt and will investigate all details of your dispute and will provide you with a written response of the outcome within 15 business days of first being notified of your dispute.
          • In some cases we may be unable to reach a conclusion within this timeframe, and may request a later response date. If this occurs, we will keep you informed of progress of the dispute no less than once every 10 days.

          Step 3: External Dispute Resolution scheme

          Should we be unable to resolve your complaint (including the IDR process referred to above) within 45 days or you are not happy with our response/handling of your complaint at any given time, you can seek an external review via our external dispute resolution scheme, administered by the Australian Financial Complaints Authority (AFCA).

          This is an independent national body and its services are free to you. As a member we agree to accept the FOS’ decision.
          You can contact the AFCA by:

          Mail: Australian Financial Complaints Authority Ltd,
          GPO Box 3, Melbourne, Victoria 3001;
          Phone: 1800 931 678;
          Facsimile: (03) 9613 6399
          Website: www.afca.org.au

          About Community Underwriting

          Community Underwriting Agency Pty Ltd (ABN 60 166 234 715, AFSL 448274) (Community Underwriting) was set up by NSW Meals on Wheels Association Inc in 2014 to specifically cater for insurance to the not for profit community sector in Australia. Our insurance products are underwritten by either Berkley Insurance Australia (Berkley) (ABN 53 126 559 706, AFSL 463129), or Mitsui Sumitomo Insurance Company Ltd (MSI) ABN 49 000 525 637 AFS License No. 2401816, the insurers. Community Underwriting acts under a binding authority as agent for the insurer(s) to issue, vary and cancel policies on their behalf.

          In all aspects of this policy, Community underwriting acts as an agent for the insurer(s) and not for you.

          About the Insurers

          The Berkley Group of companies is led by Berkley Corporation, located in Greenwich, Connecticut, USA. It is listed on the New York Stock Exchange under the symbol WRB. Member companies of the Berkley Group have offices across the USA and in the United Kingdom, South America, Continental Europe, Australia, Singapore and Hong Kong.

          Mitsui Sumitomo is part of the Tokyo listed MS&AD Insurance Group with a network of offices across 42 countries and regions. You can learn more about MSI at www.msi-oceania.com

          A member of the

          Underwriting Agencies Council
          CQIB Members Badge

          Sydney Office

          Unit 24 Waterview Wharf,
          37 Nicholson Street,
          Balmain East NSW 2041

          (02) 8045 2580
          enquiries@communityunderwriting.com.au

          Brisbane Office

          Unit 4,
          151 Caxton Street,
          Paddington QLD 4006

          (07) 3558 8478

          Legals

          Our Financials Services Guide
          Our Privacy Statement
          Our Domestic and Family Violence Policy

          Any advice provided is general in nature and does not consider your specific objectives, financial situation or needs. You should carefully read the relevant policy and/or Product Disclosure Statement (PDS) to ensure any particular product is right for you

          2022 Community Underwriting Agency Pty Ltd. All rights reserved. Community Underwriting Pty Ltd ABN 60 166 234 715 AFS No. 448274