On-line Superannuation Fund Trustees Liability Insurance



Thank you for considering our on-line superannuation fund trustees liability insurance service.   Because Greater National Group is an insurance broker, not an insurance company, we will process your application with major insurance companies in order to find the right superannuation fund trustees liability insurance for you.

Please fill in the following form as fully as possible, then click 'submit' at the end of the form.
You can use the TAB key to move to the next field. We will respond with your terms as soon as we have researched the market for the right available deals that fit your requirements.


The Trust/Employer
1a. Name of the Trust (Superannuation Fund):
1b. Name and Address of Employer(s) contributing to the Trust:
1c. Nature of Business of Employer:
1d. Commencement Date of the Trust:
2a. Is the Trust:
Accumulation Defined Others
If 'Others', please provide details:
2b. Are any assets of the Trust invested in any one entity equal to 5% or more of the Total Assets of the Trust?
Yes No
If 'Yes', please provide additional information:
2c. Has the Trust received notice of non-compliance with relevant legislation?
Yes No
If 'Yes', please provide additional information:
Service Providers and the Fund
3. Please provide information for the latest two years as follows
20 20
Active Members
Deferred Members
Members Receiving Pension
Total
Annual Contribution
Total Assets
4a. Please provide the name of the actuary of the Trust:
4b. When was the last actuarial valuation of the Fund?
4c. Are the Trustís Funds considered adequate to meet future obligations of the Trust?
Yes No
If 'No', please provide additional information:
5a. Please provide the name(s) of the investment manager(s) of the Trust:
5b (i). Does the Trust have a current investment strategy which complies with Section 52(2)(f) of the SIS Act?
Yes No
If 'No', please provide additional information:
5b (ii). Is the strategy reviewed and updated regularly?
Yes No
If answer is yes, at what intervals is the strategy reviewed and updated?
If No, please provide additional information:
5c. Are all investments made in accordance with an Investment Strategy formulated in accordance with Section 52 (2) (f) of SIS Act?
Yes No
If 'No', please provide additional information:
5d. Does the investment Manager manage all investments of the Trust?
Yes No
If 'No', please provide additional information including how investments are managed as well as qualifications and experience of persons handling the investments.
6. Please provide the name(s) of the following service providers:
a. Administrator:
b. Superannuation Consultant:
c. Solicitor:
Claims/Limit of Liability
7a. Have any of the Trustees ever been refused this type of Insurance or had similar insurance cancelled or declined to renew or imposed special terms?
Yes No
If 'Yes', please provide details:
7b. If an insurance similar to that now proposed had been or were in effect would any claim which had been made or which is now pending against any Trustee proposed for insurance have fallen within the scope of such insurance?
Yes No
If 'Yes', please provide details:
7c. Have there been any claims made or claims circumstances that have not been reported to Greater National Group?
Yes No
If 'Yes', please provide details:
Limit of Liability
8a. Limit of Liability required:
8b. If currently insured, details of existing insurer, indemnity limit and period of insurance:
9. For the purpose of computing the Stamp Duty of the insurance, please provide us with a breakdown of numbers of employees of the Trust applicable to each State, Territory and Overseas:
NSW  VIC  QLD  SA  WA  ACT  TAS  NT  O/S
               
Required Documents
10. Documents to be attached to the proposal form.
Please email/fax/mail the following documentation in support of your application:
  • Latest annual financial statement/report distributed to members.
  • Latest financial statements of Sponsoring Employer(s).
  • Latest ISC Return Form.


Duty of Disclosure:
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?
Yes No
If so, please provide details:
I/We hereby declare that:
My/Our attention has been drawn to the Important Notices accompanying this form and further I/we have read these notices carefully and acknowledge my/our understanding of their content. The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter between the date of this form and the inception date of the insurance to which this relates I/we shall give immediate notice thereof. I/We authorise GNG and the Insurer to collect or disclose any personal information about another individual (for example, an employee, or client), I/we declare that the individual has been or will be made aware of that fact and the Privacy Policy. I/We also confirm that I/we am/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 form and I/we complete this form on their behalf.
Any other comments, requests or relevant information you need to add:
Contacting you about your quote:
In order to select the most appropriate cover for you, it may be important to discuss quote details in person. Please leave a contact phone number and best time to call to facilitate this.
Your full name:
Company/Business/Name of Applicant to be Insured:
ABN:
Your phone number (please include area code):
Your mobile phone number:
Best time(s) to call:
Please send my quote by (select at least one):
email phone fax mail
Your email address:
Your website address:
Your fax number:
Your postal address:
Country: