Public/Products Liability Application

Fill are required fields.. Please complete all compulsory fields – those marked with *

This policy is only available to Australian registered business.

Where did you hear about Dj Insurance Services

Have you previously spoken to a Dj Insurance Services Representative regarding this quote? (*)

Name of Insured (*)

ABN

Contact Name (*)

Postal Address (*)

Suburb (*)

State (*)

Postcode (*)

Phone Number (*)

Email Address (*)

Website Address (if applicable)

Brokerage Name (*)

Contact Name (*)

Postal Address (*)

Suburb (*)

State (*)

Postcode (*)

Phone Number (*)

Email Address

Clients Address (*)

Clients Website Address

Please describe your activities in as much detail as possible (*)

Date that cover is required to commence (*)

Limit of cover required

Estimated annual income (turnover)? (*)

Do you use contractors / sub-contractors? (*)

Subcontractors own liability is excluded under this insurance (except for contracted or substitute performers). Please ensure all subcontractors carry their own liability insurance.

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

Note: If yes, please note that this insurance will not cover claims arising from activities where you are an event organiser or event promoter or self-promoter of your own performance. You will need alternative insurance. Please either contact our office to discuss further or complete our Entertainment & Events Liability proposal.

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

Note: a hold harmless or indemnity agreement is whereby one party assumes the liability risks of another party under contract. Your public liability policy is to cover your legal liability and no one else’s, therefore claims arising from these agreements is excluded. Please do not sign these agreements. If you do without first referring them to your insurer, you may not be covered in the event of a claim.

Will your performance activities include (*)

Audience participation with use of fire, sporting, hazardous or dangerous activities
Fireworks or pyrotechnics
Use of animals
Use of amusement rides or devices
Running of workshops
Any activities conducted outside of Australia
None of the above

Have you::

a) Ever had any insurance policy cancelled or renewal not offered

b) In the last five (5) years suffered any public liability claims or have caused incidents that could give rise to a public liability claim? (*)

c) In the last ten (10) years had had any criminal convictions and/or had insurance refused in the last ten (10) years? (*)

d) In the last five (5) years been prosecuted under any health and safety legislation or similar laws?

e) Ever been declared bankrupt or had a financial interest in a business that has been prosecuted under any health and safety legislation or similar laws in the last five (5) years?

Important Information

Privacy Policy

Safe Hands Insurance Group Pty Ltd T/As DJ Insurance Services (ABN: 69 163 926 261 AR No 4400038 as Authorised Representative of Winley Insurance Group Pty Ltd ACN 138 133 285 ABN 39 138 133 285 AFS Licence No 343573), is committed to protecting your privacy in accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles. Our Privacy Policy describes our current policies and practices in relation to the collection, handling, use and disclosure of personal information. It also deals with how you can complain about a breach of the privacy legislation and also, how you can access the personal information we hold and how to have that information corrected.

Please visit This Link to download our full privacy policy.

Your Duty of Disclosure What you need to disclose:

Before you enter into a contract of general insurance with us, you have a duty under the Insurance Contracts Act 1984 to disclose every matter that you know, or could reasonably be expected to know that would be relevant to the insurer’s decision whether to accept the application of the insurance and, if so, on what terms and conditions.

What you are not required to disclose Your duty does not require disclosure of any matter: 1. That diminishes the risk to be undertaken by us; 2. That is of common knowledge; 3. That we know or, in the ordinary course of our business, ought to know; 4. Where compliance with this duty is waived by us.
Consequences of non-disclosure

If you fail to comply with your duty of disclosure obligations and/or have not answered the questions honestly in your application and not advised what you, as a reasonable person in the circumstances would have answered, the insurer may be entitled to reduce their liability under the contract in respect of a claim or may cancel the contract.

Fraudulent non disclosure and its consequences

If your non disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning - i.e. treat the agreement as if it never existed.

Subrogation

You may prejudice your rights with regard to a claim if, without prior agreement from the Insurer, you make agreement with a third party that will prevent the Insurer from recovering the loss from that, or another party.

Your policy contains provisions that either exclude the Insurer from liability or allows them to reduce their liability in the event that you have entered into any agreement that excludes your rights to recover damages from another party in relation to any loss, damage or destruction which would otherwise allow you to sustain a claim under this policy.

1. I have read and understand the Duty of Disclosure Information (*)

Yes

2. I have read and understand the Subrogation Clause (*)

Yes

3. Please enter the code shown below (*)

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