Breeze Underwriting Application Form Accommodation Insurance

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Hortense Bishop
5 years ago
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1 Applicatin Frm Accmmdatin Insurance Send qutatin requests t: Phne: Imprtant Ntices The Cver Please read the Hspitality Business Pack Plicy available n ur website befre applying fr this insurance. It cntains imprtant infrmatin t help yu understand the prduct and decide whether it is apprpriate fr yu. Wrkers cmpensatin is cmpulsry in all States and Territries f Australia. This Business Pack des nt include Wrkers cmpensatin cver. Duty f Disclsure Under the Insurance Cntracts act 1984 (the Act), yu have a duty f disclsure. Yu are required befre yu enter int, renew, vary extend r reinstate yur Plicy, t tell us everything yu knw and that a reasnable persn in the circumstances culd be expected t knw, is a matter that is relevant t ur decisin whether t insure yu, and anyne else t be insured under the Plicy, and if s, n what terms. Yu dn t need t tell us abut any matter: that reduces the risk, is f cmmn knwledge, that we already knw, r ught t knw in the rdinary curse f ur business as an insurer, r we indicate we d nt want t knw. If yu d nt tell us If yu d nt cmply with yur Duty f Disclsure we may: reduce r refuse t pay a claim, r cancel yur Plicy. If yur nn-disclsure is fraud, we may als have the ptin f aviding the Plicy frm its beginning. Privacy Privacy legislatin regulates the way private sectr rganisatins can cllect, use, keep secure and disclse persnal infrmatin. has develped a privacy plicy which explains what srt f persnal infrmatin we hld abut yu and what we d with it. Yu can btain a cpy f the Privacy infrmatin brchure by cntacting us at r frm ur website A business unit f Prfessinal Services Crpratin Pty Ltd ABN AFS Licence N Page 1 f 7

2 Brker Details Brkerage: Brker Cntact: Phne: Client Details Insured Name: Trading Name: Perid f insurance: Frm: / / T: : / / expiring 4.00pm Phne/ /Website: ABN: Current Insurance Details Current Insurer: Current Brker: Lcatin Address: Suburb: State: Pstcde: Occupatin Acceptable Risks (please tick) Mtel Htel butique accmmdatin Serviced Apartment (shrt term stay) Guesthuse Hliday Cabins B&B Traditinal Unacceptable Risks include: Backpackers/Bunkhuse Caravan Park Htel/Pub/Tavern Resrt Health Retreat Farm Stay B&B Self catering A business unit f Prfessinal Services Crpratin Pty Ltd ABN AFS Licence N Page 2 f 7

3 Trading Activity Is the business a AAA Turism member? Yes N If s what is the membership number? Star Rating Hw many accmmdatin rms are there? Des the manager have mre than 2 yrs experience managing this business? Yes N Des the wner/manager/staff live r are present n-site 24 hurs a day? Yes N If N, prvide details f day t day site management? What is the Annual turnver? $ Nn-Accmmdatin turnver % Des the business have a license t sell alchl? Yes N Is there a restaurant ther than fr breakfasts nly? Yes N If yes, what is the seating capacity? Is there a functin r cnference centre? Yes N If yes, cmplete the Nn-Accmmdatin field abve and advise seating capacity: Is there a swimming pl r utdr spa? Yes N If yes, is it fenced t Australian Standards with signs psted specifying usage, accepted behaviur and life saving prcedures? Yes N D all ther public/guest facilities cnfrm with all lcal, regulatry and/r Australian Standards? Yes N Premises What is the year f cnstructin? If ver 50 years, has premises been fully renvated fr its current purpse? Yes N If ver 20 years, has premises been fully rewired OR within the past 5 years had an electrical inspectin cnducted OR been thermgraphically scanned with n faults recrded? Hw many flrs des the building have? Yes N Is the building subject t Heritage r Natinal Trust listing? Yes N Is there a reticulated twn water supply prvided by a public supply authrity? Yes N Is there any asbests in r n the premises? Yes N Any f the premises cnstructed with Expandable Plystyrene Fam (EPS)? Yes N Cnstructin Walls: Brick r cncrete Irn Timber r fibr cement Other Grund Flrs: Cncrete Timber Other Flrs: Cncrete Timber A business unit f Prfessinal Services Crpratin Pty Ltd ABN AFS Licence N Page 3 f 7

4 Fire Prtectin is the premises fitted with: Hse reels/hydrants Yes N Smke detectrs hardwired and cnnected t fire brigade/mnitring cmpany Yes N Fully Sprinklered and installed pst 1962 and cmpliant with Australian Yes N Standards and subject t a current service cntract Security Excluding guest rms, are external drs fitted with duble keyed Deadlcks Yes N Is the premises fitted with a mnitred back t base alarm Yes N Is the premises fitted with a lcal alarm (siren) Yes N Is banking cnducted n a daily basis Yes N If n, hw ften is banking cnducted D yu keep mney in a safe Yes N If yes, refer t plicy definitins f requirements fr cverage in a safe Cmmercial Cking Cnditin If there are cmmercial cking facilities at the Lcatin, it is a cnditin f this plicy that the Insured ensures that the fllwing minimum standards are cmplied with: 1. That the exhaust / extractin system ducting is prfessinally cleaned annually 2. That the exhaust / extractin system filters are cleaned weekly 3. That a minimum f 2 x 4.5kg dry chemical extinguishers are lcated within the kitchen at a suitable lcatin which generally cmplies with the fllwing requirements: 3.1 the extinguishers shall be in a cnspicuus and readily accessible psitin 3.2 where practicable, the extinguishers shall be lcated alng nrmal paths f travel and near exits 3.3 they shall nt be lcated in areas where they will be expsed t temperatures utside f the range 50C t -50C 4. That a fire blanket is lcated in the kitchen. 5. Charcals must either be remved frm the premises and extinguished, r a stainless steel lid placed ver the tp f the charcal bed during nn trading hurs. If Yu d nt carry ut r maintain these minimum standards, We may reduce r refuse t pay a claim r may cancel this plicy. I cnfirm that I am cmpliant with the abve cnditins Yes N Nt Applicable If N, prvide details A business unit f Prfessinal Services Crpratin Pty Ltd ABN AFS Licence N Page 4 f 7

5 General Has the insured r any partner(s) r directr(s) f the business: Had any insurance declined r cancelled, prpsal/applicatin rejected, renewal refused, claim rejected, special cnditins r excess impsed by an insurer Yes N Ever been declared bankrupt Yes N Ever been invlved in a cmpany r business which became inslvent r was subject t any frm f inslvency administratin Yes N Been cnvicted f any criminal ffence (ther than minr traffic ffences) within the last 5 years Yes N Been penalized r cnvicted under any Health r Fd Act r ther authrity Yes N If yu have answered Yes t any f these questins, please prvide details belw: Claims Has the insured r any partner(s) r directr(s) f the business had any claims in the last 5 years OR suffered any lss r damage that wuld have been cvered by the prpsed insurance plicy? Yes N If Yes, please prvide details: Date f lss Excess Lss ($) Descriptin f lss Signature and Declaratin By cmpleting and signing this applicatin frm: Yu declare that: 1. yu have read and understd yur Duty f Disclsure and the Hspitality Business Pack and agree t be bund by its terms and cnditins shuld the applicatin be accepted; 2. the disclsed infrmatin in this applicatin is true an accurate in every respect and n infrmatin has been withheld which is likely t affect ur decisin abut accepting this insurance; 3. if there is mre than ne insured and all have nt signed this applicatin, yu have signed fr and n their behalf; 4. yu acknwledge we reserve the right t decline any applicatin. Yu cnsent t: 1. the use and disclsure f yur persnal infrmatin fr the purpses shwn in the Privacy Sectin in the Hspitality Business pack; 2. ur btaining claims and ther infrmatin relating t this insurance frm my previus insurers r any credit reference bureau. Applicant s Signature(s) Date Applicant s Title A business unit f Prfessinal Services Crpratin Pty Ltd ABN AFS Licence N Page 5 f 7

6 Cverage Required Prperty Excess: $500 $1,000 Building $ Cntents including Stck $ Remval f Debris; autmatic cver $50,000 $ Business Interruptin Excess same as Prperty Grss Incme $ *Mney paid r payable t yu fr gds sld and/r services rendered r fr rent received r payable (plus utgings specified in any lease) in the curse f the business less purchase cst f stck. Additinal Increased Cst f Wrking; autmatic cver $25,000 $ Claims preparatin csts; autmatic cver $20,000 $ Indemnity perid 6 mnths 12 mnths 18 mnths 24 mnths Theft Excess same as Prperty Cntents and Stck excluding Tbacc Prducts $ Mney Excess same as Prperty Blanket cver subject t Limits fr 3) & 5) belw $ Cvering Mney Under items 1-5 belw with Mney n Business Premises during Business hurs and in Private Residence limited t a maximum f $ 7,500 r the sum insured whichever is the lesser 1) Mney in Transit 2) Mney n Business Premises 3) Mney n Business Premises utside Business hurs 4) Mney n Business Premises in a lcked Safe r Strngrm 5) Mney in a Private Residence Machinery Breakdwn Excess: $500 $1,000 $2,000 Limit any ne Item $10,000 $20,000 If cver required fr any Item in Excess f $ 20,000, prvide full details f each Item Deteriratin f Stck $ A business unit f Prfessinal Services Crpratin Pty Ltd ABN AFS Licence N Page 6 f 7

7 Electrnic Equipment Excess same as Prperty Limit any ne Lss $ Electrnic Data and Electrnic Data Media $ Increased Cst f Wrking $ Bradfrm Liability Excess same as Prperty Limit f Liability $10,000,000 $20,000,000 Glass Excess same as Prperty Replacement Value Yes N Cver Standard Limit Revised Limit 1) Temprary Prtectin and shuttering $7,500 2) Items Affixed t glass $7,500 3) Shpfrnts $7,500 4) Damage t Prperty $7,500 5) Damage t electrical signs $7,500 General Prperty Items Excess same as Prperty Descriptin $ Descriptin $ Descriptin $ Descriptin $ Emplyee Dishnesty Excess same as Prperty Sum Insured $10,000 $20,000 Nt Required Tax Audit Excess same as Prperty Sum Insured $10,000 $20,000 Nt Required Transit Excess same as Prperty Sum Insured $10,000 $20,000 Nt Required Emplyment Practices Excess: $2,500 $5,000 Sum Insured $100,000 $250,000 Nt Required Statutry Practices Excess: Nil $2,500 Sum Insured $250,000 Nt Required A business unit f Prfessinal Services Crpratin Pty Ltd ABN AFS Licence N Page 7 f 7

Application Checklist: Supporting documents you need to provide with your application: o Application fee

Application Checklist: Supporting documents you need to provide with your application: o Application fee Applicatin fr Special Licence Sectin 138, Sale and Supply f Alchl Act 2012 General infrmatin: Office Use Only An applicatin fr a special licence MUST be ldged at least 20 wrking days befre the event(s)