Private Fine Art Insurance Fm 2017 Please complete and return this proposal fm via post, email fax using contact details on page 3. Answer all questions in full. Befe completing this fm must read page 3, as a requirement of Insurance Contract Act. Duty of Disclosure Befe enter into into a a contract of of insurance, general life have insurance a duty under with an Underwriter Insurance Contracts have Act a duty, 1984 under (Clth) to disclose Insurance anything Contracts that Act. know, 1984, to disclose could reasonably to Underwriter be expected every to know, matter that that affect know, insurer s could decision reasonably to insure be expected and to on know, what terms. is relevant You have to that Underwriter s duty after proposal, decision and wher up until to accept time insurer risk of agrees insurance to insure. and, You if so, have on what same terms. duty You befe have renew, same duty extend, to disclose vary reinstate se matters a contract to of Underwriter insurance. You do befe not need to renew, tell extend insurer anything vary reinstate that: this contract of general insurance. Your duty, however does not require disclosure of any matter: that reduces diminishes risk that Underwriter s is insured; risk that is common is of common knowledge; knowledge that r insurer Underwriter knows should knows, know in as an dinary insurer; course of business, should know as to insurer which waives compliance compliance with r with r duty duty of disclosure of disclosure. waived by Underwriter. are uncertain about wher not a particular matter should be disclosed to insurer, please contact r Aon Client Manager. Non-Disclosure Non-disclosure fail to comply with r duty of disclosure Underwriter be entitled to reduce liability under contract in respect of a claim do cancel not tell r contract. insurer anything r non-disclosure are required is fraudulent, to, insurer Underwriter cancel r contract also have reduce option amount of avoiding that it is contract required from to pay its if beginning. make a claim, both. r failure to disclose is fraudulent, insurer refuse to pay a claim and treat contract as if it never existed. Subrogation Subrogation and non-admission The policy/ have policies entered contain into an provisions agreement which with have an effect party of which excluding prevents limiting Insurer insurer s from taking liability a recovery in respect action of a loss, f compensation where have from that admitted party liability it affect prejudiced r right to insurer s cover under rights of this subrogation. Policy. Should This now occur be where a party to are such a party an agreement to an agreement be requested which excludes to enter limits such an an agreement insurer s rights in to recover future please loss advise from an this office party. in writing. 1. Personal Details Insured Name ABN (if applicable) Full Business Description (if applicable) Risk address Phone Email Mobile Fax Occupation Postal Address if different from above Private Fine Art Insurance Fm 2017 Page 1 of 5
2. Premises Is main residence? (a) built of brick, stone concrete Yes No (b) roofed with slate, file, asphalt, metal concrete? Yes No (c) is in good condition/repair Yes No have answered no to any of above, please provide full details (d) do have additional locations that require to be covered by this policy? Yes No yes, please complete Additional Location Sheet attached f each additional location 3. Protection (a) is a burglar alarm fitted? Yes No (b) is alarm connected to a police and/ central station? Yes No (c) is alarm maintained under a contract? Yes No (d) state types of locks on all external dos, e.g. five lever mtice deadlock, etc (e) state types of locks on all accessible windows and skylights, e.g. screw key operated, etc (f) please advise wher following are present Fire Extinguishers Fire Alarms Smoke Detects Ors (please specify) (g) are fire alarms/smoke detects connected to a central station/monited alarm? Yes No 4. Collection Please provide total sums to be insured f following categies (In Australian Dollars): Please attached a breakdown (Schedule) of all items and values that make up total sums to be insured Pictures and painting Drawings, prints, books and like Antique Furniture Antique clocks, watches and mechanical artefacts Ceramics, pcelain, glass and items of brittle fragile nature Non fragile sculptures Fragile sculptures Gold, silver and precious metals Jewellery Or valuables/collectibles (Please specify below) What is value of single most valuable item in r collection? Private Fine Art Insurance Fm 2017 Page 2 of 5
5. Previous insurance Have any member of r immediate family/household ever sustained any loss losses Yes No which would have been covered by this type of insurance had it been in fce? yes, please provide full details f each incident and give approximate date, brief circumstances and amount Circumstances Date Amount Name of current insurer (if any) Name of current broker (if any) Expiry date of current policy Has any insurer declined to accept/cancelled/refused to continue agreed to continue on special terms any insurance f any person to whom this insurance would apply? Yes No yes, please provide full details Private Fine Art Insurance Fm 2017 Page 3 of 5
6. Declaration and Signature You must tell us anything that know, should know, could affect our insurer s decision to insure and/ terms on which y insure. You must do this when apply, renew r policy, when change re-instate r policy. When we ask specific questions, must answer se questions truthfully and in a way that a reasonable person in circumstances would answer m. It is imptant that every person who will be insured by policy answers all questions in this way. These requirements are part of Insurance Contracts Act 1984. I hereby acknowledge that I have complied with duty of disclosure which is stated above. I confirm that answers and statements in this proposal are crect and that no infmation has been withheld which affect r decision to accept this proposal terms of proposed Policy. Signature Date Aon has always valued privacy of personal infmation. would like a copy of our Privacy Policy, can contact us access it from our website at www.aon.com.au. Your Premium Calculation The key facts that affect r premium are reflected in questions asked in this document and infmation sought at time of taking out r insurance. Terms of Credit Our terms of credit f clients are indicated on invoice provided upon entering into Insurance Contract. Aon is conscious of occasional hardship and understands need to refer clients; if considered appropriate; to Australian Financial Counsells and Credit Refm Association. Aon acts in accdance with requirements of ACCC and ASIC debt collection Guidelines : f Collects and Credits to arrange f collection of outstanding amounts. Complaint and Dispute Resolution Any enquiry complaint relating to r policy a claim should be address to r Client Relationship Manager in first instance. r complaint is not satisfactily resolved within 5 wking days, please contact Aon s National Complaints Manager, who will attempt to resolve it in accdance with our Complaints and Disputes Handling Policy. You obtain a copy of this policy from National Complaints Manager from our website: www.aon.com.au are still not satisfied with outcome determined within 10 wking days, should contact Lloyd s Underwriters General Representative in Australia, Suite 2, Level 21 Angel Place,123 Pitt Street, Sydney, NSW 2000. Telephone Number: (02) 9223 1433 / Facsimile Number: (02) 9223 1466 / peter@lloydsaustralia.com.au. r concern is with Insurer, contact Financial Ombudsman Service by calling 1300 780 808. General Insurance Code of Practice Aon is bound by General Insurance Code of Practice and have processes in place to adhere to requirements of Code. All details relating to Code can be found at www.codeofpractice.com.au FORM SUBMISSION DETAILS Please return this proposal fm via post, email fax using following contact details: Amy Wadswth - Client Manager Aon Risk Solutions, 201 Kent Street, Sydney, NSW 2000 e: amy.wadswth@aon.com f: +61 2 9253 7269 Private Fine Art Insurance Fm 2017 Page 4 of 5
Additional Location(s) (Please complete if applicable) 7. Premises Address Is this additional location: (a) built of brick, stone concrete Yes No (b) roofed with slate, file, asphalt, metal concrete? Yes No (c) is in good condition/repair Yes No have answered no to any of above, please provide details 8. Protection (a) is a burglar alarm fitted? Yes No (b) is alarm connected to a police and/ central station? Yes No (c) is alarm maintained under a contract? Yes No (d) state types of locks on all external dos, e.g. five lever mtice deadlock, etc (e) state types of locks on all accessible windows and skylights, e.g. screw key operated, etc (f) please advise wher following are present Fire Extinguishers Fire Alarms Smoke Detects Ors (please specify) (g) are fire alarms/smoke detects connected to a central station/monited alarm? Yes No Private Fine Art Insurance Fm 2017 Page 5 of 5 COM0373C 0517