Queensland Rugby League 2019 Insurance Declaration National Rugby League Whole of game program. Name of club: sport.ajg.com.au

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1 sport.ajg.com.au Connect and join the conversation Queensland Rugby League 2019 Insurance Declaration National Rugby League Whole of game program Name of club: To be completed and returned directly to Gallagher, by no later than 28 February

2 Queensland Rugby League 2019 Insurance Declaration Arthur J. Gallagher Co (Aus) Limited ABN AFSL Main Street, Beenleigh, QLD 4207 PO Box 302, Beenleigh, QLD 4207 T: 1800 SPORT 0 ( ) E: sport@ajg.com.au sport.ajg.com.au Attention: Committee Members QRL Affiliated Clubs and Local Leagues Dear Committee Members, Re: 2019 Whole of Game Insurance Program It is compulsory that each Affiliated Club and Local League (where applicable) effects for its Teams, the minimum level of Insurance cover by 28 February Please note a Loss of Income Weekly Benefit of $300 per week, is now built into all U19 s, U20 s and Senior teams coverage. Should you require increased cover, top up options are available. Club Management Liability (Part B. page 6) is compulsory and must be selected. The level of benefits provided by the Program are not comprehensive and as such the QRL and Gallagher encourage all participants to take out Private Health, Life and Income Protection Insurance according to their own individual circumstances. It must be clearly understood that after being informed of the level of cover taken out by a Club or Local League, it is an Individual s responsibility to ensure that he / she has adequate Insurance cover for his / her needs. It is essential that each Club and Local League Executive advise all Players, Officials and Volunteers associated with its Teams of this level of Insurance cover and any additional cover it has taken out. To assist in advising all participants of their minimum insurance cover we have produced a Quick Guide to the 2019 QRL Community Insurance Program that must be distributed to all participants by Clubs and Local Leagues (where applicable). Your 2018 cover will expire at 4pm on 31 December Gallagher will arrange for the minimum 2019 cover to take effect from 4pm 31 December 2018 for all Affiliated QRL Clubs and Local Leagues. You must complete this Insurance Program Declaration and return directly to Gallagher, by 28 February 2019 together with your premium payment / loan agreement and a copy of any contractual agreements entered into by the organisation. Yours sincerely Gallagher Sport Page 2 Gallagher NRL Whole of Game Program

3 Important Dates and Information 4pm 31 December 2018 to 4pm 28 February 2019 Training and participating in trial / non fixture games sanctioned by QRL: Cover provided to those Players / Coaches who: Were registered with a QRL Affiliated Club / Local League for the 2018 season; or Are registered with a QRL Affiliated Club / Local League for the 2019 season; or Have listed on a trial and train register with a QRL Affiliated Club / Local League for the 2019 season. 4pm 28 February 2019 to 4pm 1 October 2019 No cover whatsoever unless Players / Coaches: Are registered with a QRL Affiliated Club / Local League for the 2019 season; and The Club / Local League has submitted its completed Insurance Program Declaration together with its payment / loan agreement to Gallagher. 4pm 1 October 2019 to 4pm 31 December 2019 Participating in fixture games sanctioned by QRL: Cover provided to those Players / Coaches who: Were registered with a QRL Affiliated Club / Local League for the 2019 season. Training and participating in trial / non fixture games sanctioned by QRL: Cover provided to those Players / Coaches who: Were registered with a QRL Affiliated Club / Local League for the 2019 season; or Are registered with a QRL Affiliated Club / Local League for the 2020 season; or Have been listed on a trial and train register with a QRL Affiliated Club / Local League for the 2020 season. Important Information Please Note: A person who has reached the age of forty (40) years or is reaching that age during a football season, and desires to participate in a game of rugby league under these Rules, must lodge with his Player s Agreement each year a Certificate or Report issued by a Registered Sports Physician or Medical Specialist in Queensland stating that the person does not have any apparent impediment, declared or otherwise, that would preclude his participation in a body contact sport. Please also note that the Public Liability and Player Accident insurance covers under the NRL Community Insurance Program which covers your club for all Rugby League activities does not extend to include non sanctioned Rugby League Carnivals or other ancillary sports such as Touch Football competitions. Gallagher has developed a policy specifically for One Off Rugby League Carnivals and other ancillary sports such as Touch Football competitions, which will protect your club for any incidents relating to these activities. Please note major Policy Exclusions of the Insurance Handbook. QRL 2019 Insurance Declaration Page 3

4 Queensland Rugby League 2019 Insurance Declaration Club Details General Details Full name of the Club (as per Incorporation Certificate) Are you registered for GST purposes? Yes No What is your ABN? Postal Address of Club Club Grounds Address Postcode Postcode Club President Treasurer Secretary Name Telephone (B/Hrs) Fax Mobile Has your Club applied for affiliation for the 2019 season and been accepted by the relevant Division? Yes No Division (Please circle) South East Central Northern ISC What League does your club play in Club Activities Does your Club hold a liquor license, outside QRL game day? Yes No If Yes, what are your trading hours? Does your Club have poker machines? Yes No If Yes, how many? What is your Club s annual turnover? $ (I.e. revenue prior to expenses) Does your Club operate another sport Yes No If Yes, what type Previous Public Liability Claims Yes No If Yes, please attach details Childminding / Playground Yes No Public Gymnasium Yes No Live Entertainment (Bands etc) Yes No Dance Floor Yes No After 1.00am Trading Yes No Provide Outside Catering Yes No Closed Circuit TV Monitoring installed Yes No Do you hire out your club to third parties Yes No If Yes, estimated income $ Page 4 Gallagher NRL Whole of Game Program

5 Property Insurance Renewal/Quote Request Declaration Property Sums Insured Material Damage Buildings $ Contents $ Stock $ Lighting & Towers $ Other $ Description Other $ Description Mobile Machinery (Tractors / Ride on Mowers etc) $ Description Registered Mobile Machinery $ Yes No Mobile Machinery $ Yes No Equipment Breakdown (Computers, Servers, Pumps, Fridges, Air Con & Compressors) Description Required $ Description Required Limit any one loss $40,000 Yes No Deterioration of stock $2,500 Yes No Data Restoration $2,500 Yes No Increased cost of working $2,500 Yes No Business Interruption Gross Profit $ Payroll (if insured separately) Other Insurances $ Does your Club take out any additional insurance cover than that provided via QRL / Gallagher? Yes No If yes, please provide details below Type of Policy Due Date Insurer Broker PLEASE NOTE: Completion of this section does not automatically effect insurance. If your changes are urgent, please contact us on 1800 SPORT 0 ( ) QRL 2019 Insurance Declaration Page 5

6 Queensland Rugby League 2019 Insurance Declaration Cost per Team PART A (Compulsory - if applicable) Grade Number of Teams Stamp Duty Exempt (**Exemption Required) Not Stamp Duty Exempt Under $68 or $70 = $ Premium Under $98 or $100 = $ Under $117 or $120 = $ Under $178 or $190 = $ Under $208 or $220 = $ Under $254 or $270 = $ Under $288 or $300 = $ Under $466 or $480 = $ Under $476 or $490 = $ Under $695 or $710 = $ Under $808 or $830 = $ Under $917 or $940 = $ Under $1,256 or $1,280 = $ Total Part A $ Cost per Club Entity PART B (Compulsory) Category Stamp Duty Exempt (**Exemption Required) Not Stamp Duty Exempt Management Liability $380 $400 Total Part B $380 or $400 (please circle) ** To qualify for the Stamp Duty Exempt Premium, you must provide a copy of your Stamp Duty Exemption Certificate each year. If you do not provide this certificate, the Stamp Duty Exempt premium, will not be accepted. To obtain certificate you must contact the Office of State Revenue. Details can be found at: Page 6 Gallagher NRL Whole of Game Program

7 Cost per Team PART C (Compulsory - if applicable) Grade Number of Teams Stamp Duty Exempt (**Exemption Required) Not Stamp Duty Exempt Under $2,730 or $2,770 = $ Premium Under $3,510 or $3,550 = $ A $3,955 or $3,990 = $ B $3,955 or $3,990 = $ C $3,955 or $3,990 = $ $3,955 or $3,990 = $ $3,955 or $3,990 = $ $1,385 or $1,395 = $ Hastings Deering $4,390 or $4,450 = $ Intrust Super $4,390 or $4,450 = $ Total Part C $ Loss of Income Top-Up Cover PART D PLEASE NOTE: A $300 per week loss of income weekly benefit is now automatically included for all senior teams / players (teams participating in U19 or above competitions). Should a team or individual player require a higher limit, there are top up options available by entering into the below table, otherwise you can direct your teams / players to Gallagher on 1800 SPORT 0 ( ) directly. Team / Individual Player Loss of Income Top-Up (Refer page 5-6 of the handbook) Team grade / Player Name: Team grade / Player Name: Team grade / Player Name: Weekly Benefit $ $ $ Premium Total Part D $ Total cost of insurance Total Premium Payable (Part A, B, C, D): $ QRL 2019 Insurance Declaration Page 7

8 Queensland Rugby League 2019 Insurance Declaration Duty of Disclosure Before you enter into a contract of general insurance with an Insurer, you have a duty at law to disclose to the Insurer anything that you could be reasonably expected to know is relevant to the Insurer s decision whether to accept the risk of the 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 disclosure of matter: that diminishes the risk to be undertaken by the insurer; that is of common knowledge; that your insurer knows or, in the ordinary course of business ought to know; as to which compliance with your duty is waived by the insurer. If you fail to comply with your duty of disclosure, the Insurer may be entitled to reduce its 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 & Acknowledgments I/We declare and acknowledge that I/We: have not suppressed, misrepresented or misstated any material information within my knowledge likely to affect the Insurers decision as to my eligibility for insurance and the answers given in the Proposal and the completed quote questionnaire are in every respect true and correct. have received, read and fully understand the details contained in the 2019 QRL Community Insurance Program Handbook. Furthermore, I acknowledge the property insurance program is an optional policy and that cover will only commence upon written acceptance of a formal quotation provided by Gallagher. acknowledge that the public liability insurance component of the insurance program is intended to provide cover for normal activities of Rugby League. Activities outside of Rugby League including but not limited to fundraising and social activities may not be covered under this policy and should be referred to Gallagher for clarification. subject to the Insurance (Agents and Brokers) Act, if this Proposal is accepted by the Insurer, the Proposal, the Policy and Schedule issued shall constitute the entire agreement between you and us, and shall supersede any prior representations or warranties. Signature of President, Treasurer or Secretary Name of President, Treasurer or Secretary Date / / Page 8 Gallagher NRL Whole of Game Program

9 Important Checklist General Has the Duty of Disclosure been signed and dated? Yes No Have you attached copies of any contractual Agreements signed by the Club / Local League? If you are claiming Stamp Duty Exempt status have you attached a copy of your certificate from the Office of State Revenue? Yes Yes No No Payment Options (tick) 1. Cheque for $ made payable to Arthur J. Gallagher is attached 2. Direct Debit Option if you wish to pay by an on-line direct debit transfer, please forward your completed declaration. On receipt we will your invoice back to you, with your own clubs dedicated Direct Debit details for easy transfer 3. Premium Funding if you wish to Fund please contact Gallagher on 1800 SPORT 0 ( ) to obtain a Funding quote, as per below process. NOTE: If you would like a funding quotation for monthly instalments please follow these steps: 1. Phone 1800 SPORT 0 ( ) and advise that you are a QRL Club requesting a Premium Funding Quotation. 2. Have your total team numbers ready. 3. A quote & contract will then be ed to you 4. If you accept the funding contract, simply complete, sign and return directly to Gallagher, together with your completed 2019 QRL Insurance Program Declaration. REMINDER: Completed documents must be forwarded directly to Gallagher, by no later than the 28 February Please return the completed Declaration together with your Payment / Loan Agreement directly to: Gallagher Sport PO Box 302, Beenleigh, QLD 4207 QRL 2019 Insurance Declaration Page 9

10 Queensland Rugby League 2019 Insurance Declaration Contacts Gallagher Branch Team Leader Gallagher Sport 25 Main Street, Beenleigh, QLD 4207 Postal Address: PO Box 302, Beenleigh, QLD 4207 Phone: 1800 SPORT 0 ( ) sport@ajg.com.au Terry Berryman Phone: (07) Mobile: terry.berryman@ajg.com.au Assistant Account Executive Samantha Freney Phone: (07) samantha.freney@ajg.com.au Page 10 Gallagher NRL Whole of Game Program

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12 sport.ajg.com.au Connect and join the 1800 SPORT 0 ( ) Arthur J. Gallagher & Co (Aus) Limited. Operates under AFSL No Any advice provided in this document does not consider your objectives, financial situation or needs. You should consider if the insurance is suitable for you and read the Product Disclosure Statement (PDS) and Financial Services Guide (FSG) before buying the insurance. If you purchase this insurance, we may charge you a fee for our service to you. Ask us for more details before we provide you with any services on this product. PDS available on request. Our FSG is available on our website, Arthur J. Gallagher & Co (Aus) Limited. ABN , Level 12, 80 Pacific Highway, North Sydney, NSW RE v1.5