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Quote Request

PARANORMAL & SUPERNATURAL INVESTIGATORS SCHEME PROPOSAL FORM

PSIS Proposal Form

YOUR DETAILS

Full Name
Full Name
First
Last
Structure
11 Digits - If No ABN Type 0
GST Registered

ADDRESS

Physical Address

Address
Address
City
State/Province
Zip/Postal

Postal Address

Same as Physical Address
Address
Address
City
State/Province
Zip/Postal

OTHER DETAILS

Do you belong to any Association

DUTY Of DISCLOSURE

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 Insurer 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 disclosure of matter.

  • that diminishes the risk to be undertaken by the Insurer
  • that is common knowledge
  • that your Insurer knows or, in the ordinary course of business, ought to know
  • as to which the compliance with your 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.

Answer all questions correctly to comply with your duty of disclosure

Do you understand your Duty of Disclosure

IN THE LAST FIVE YEARS HAVE YOU OR THE BUSINESS EVER HAD

Any Claims
Any Convictions
Ever Been Declared Bankrupt

YOUR INSURANCE DETAILS

Are you currently insured
Do you want to upload your current policy or renewal notice
Maximum upload size: 5MB

BUSINESS ACTIVITIES OR SERVICES PROVIDED

You can select more than one option

TURNOVER

Turnover is the total gross sales/invoices generated by the business, less the GST, but including all payments made to sub-contractors. Turnover is not the actual or estimated profit or pre-tax profit of the business.

STAFF

COVER REQUIRED

IMPORTANT INFORMATION

Sub-Contractors - Exclusion

This Policy covers you for the vicarious liability arising from any sub-contractor you engage, but does not cover the actual sub-contractor.

We remind you of the importance of ensuring that all contractors and sub-contractors used by you maintain adequate professional indemnity, public & products liability and workers compensation insurances. You should ensure their insurance cover is in force before you authorise any work to commence and annually check that these covers are in place

Minimum & Deposit Premium

This means that there is no refund of premium if you subsequently cancel the policy prior to the normal expiry date. Please note that we treat our remuneration as fully earned when we issue you with a tax invoice. We retain all of our commission, fees and other remuneration in full in the event of any mid-term cancellation of a policy.

I HAVE READ AND UNDERSTOOD

DECLARATION

I/We hereby declare that:

My/Our attention has been drawn to the Important Notice of this Proposal form and further I/We have read these notices carefully and acknowledge my/our understanding of their content by my/our signature/s below.

The above statements are true, and I/we have not suppressed or misstated any facts and should any information given by me/us alter between the date of this Proposal form and the inception date of the insurance to which this Proposal relates I/we shall give immediately notice thereof.

I/We authorise you, to collect or disclose any personal information relating to this insurance to/from any insurers or insurance reference service. Where I/we have provided information about another individual I/we declare that the individual has been or will be made aware of that fact.

I/we also confirm that the undersigned is/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this Proposal form, and I/we complete this Proposal form on their behalf.

Where a Policy is issued on a “minimum and deposit” premium basis, the annual premium is a minimum and deposit premium, which means that there is no refund of any premium or fees and charges in the event you cancel the policy before the normal expiry date or the policy is cancelled by the insurer prior to the normal expiry date. By signing this proposal form you acknowledge your understanding and acceptance of this condition.

Your Name
Your Name
First
Last

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