Childcare Insurance Quote

Insured Detials

  Yes No

Long Day Care   Outside School Hours Care   Vacation Care   Occasional Care   Preschool/Kindergarten   Home Based Care   Nanny     Babysitter     Other

Claims History – for all products selected on this quote slip

  Yes No

Section One – Public and Products Liability and Professional Indemnity


$5 million      $10 million      $20 million
  Yes No
  Yes No

Do you require the following optional policy extensions:

  Yes No
  Yes No
  Yes No

Section Two – Personal Accident

Number of Volunteers?

What is the total number of children registered with the service?

  Yes No
  Yes No

Section Three – Property

(if more than one situation please provide details for each situation)

  Yes No
Material Damage
Construction: If more than one type of construction include % beside each construction type
  Yes No
  Yes No
  Yes No
  Yes No
  Yes No
  $25,000   Other
  $25,000   Other
  $25,000   Other
  $25,000   Other
  Yes   No
  Yes No
  $5,000   $10,000   Other
  $5,000   $10,000   Other

Section Four – Management Liability

  Yes No
  Pty Ltd   Incorporated Not for Profit   Other
  Yes No
  Yes No
What is the Company turnover?

  Yes     No
  Yes No

Fidelity Section

Does the Company segregate duties so that no ONE individual can control the following from commencement to completion without referral to others:
  Yes   No
  Yes   No
  Yes   No

Your Duty of Disclosure

In accordance with the provisions of the Insurance Contracts Act 1984 (Section 22), we are required to advise you of your responsibilities in relation to the disclosure of relevant information.

Before you enter into a Contract of General insurance with an Insurer, you have a duty under the Insurance Contracts Act 1984 to disclose to the Insurers every matter that you know, or could reasonably expect to know, is relevant to the Insurer’s decision whether to accept the risk of insurance and, if so, on what terms. You have the same duty to disclose those matters to the Insurer before you renew, extend, vary or reinstate a Contract of General Insurance. Your duty however does not require disclose of matters:
a) that diminishes the risk to be undertaken by the Insurer;
b) that is common knowledge;
c) that your Insurer knows or, in the ordinary course of business, ought to know;
d) as to which the compliance with our duty is waived by the Insurer.

Non-Disclosure

If you fail to comply with your Duty of Disclosure, the Insurer may be entitled to reduce the liability under the Contract in respect of a claim or may cancel the Contract.

If your non-disclosure is fraudulent, the Insurer may also have the option of avoiding the Contract from its beginning.

Declaration

I declare that the contents of this form are true and that I have not omitted any material information. If this information differs before the contract of insurance is concluded, I will tell the Insurers.

  I have read and agree to the Duty of Disclosure.

 

Head Office

10/39 Eucumbene Drive Ravenhall VIC 3023

 

Contact Us

Phone: 03 8358 5977

 

Email

support@haiseyinsurance.com.au