Associations and Non-Profit Organisations Liability Insurance


Thank you for considering our on-line associations and non-profit organisations 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 association and non-profit organisation 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.

Your Details
1. Full legal name of the Association
2. Date(s) of commencement of business
3. Are you registered for GST purposes?
No Yes
If 'Yes', What is your ABN?
4. Principal Address
Postcode:
5. Is the Association an incorporated body?
No Yes
If 'Yes', under what legislation is it incorporated?
6. Is the Association a subsidiary of another entity?
No Yes
If 'Yes', please state the name of the ultimate holding company
7. Prior corporate entity.
Has the name of Association detailed in answer to Question 1 been changed, or has any other business been purchased or has any merger or consolidation of your business taken place?
No Yes
If 'Yes', please detail changes in chronological order
8. Specify the nature of the Association (including subsidiaries)
Trade Association Professional Association Charitable organisation Social organisation Other
If Other, please provide details
9. Does the Association or any of its subsidiaries act as a manager of any fund or property for or on behalf of any third party?
No Yes
If 'Yes', please provide details
10. Total number of
Paid Staff Volunteers Members Contractors
11. Are you stamp duty exempt?
No Yes
If 'Yes', please provide copy & paste or email evidence of the exemption.
If 'No', please provide a percentage breakdown of your revenue in the last 12 months
NSW VIC QLD SA NT WA ACT TAS OS
 %  %  %  %  %  %  %  %  %
Claims and Circumstances
12a. At any time in the past, has any claim been made against the Association or any Office Bearers, Executive Staff, Sub-committee members, employees of the Association?
No Yes
If 'Yes', please provide details
12b. Are there any circumstances not already notified to insurers which may give rise to a claim against the Corporation, or any Office Bearer, Executive Staff, Sub-committee members, employees of the Association?
No Yes
If 'Yes', please provide details
12c. If insurance similar to that now proposed has been, or were now in effect, would any claim which had been made, or which is now pending against the Association or any person proposed for insurance, have fallen within the scope of such insurance?
No Yes
If 'Yes', please provide details
12d. Is any person proposed for insurance aware, after enquiry, of any circumstances or incident which he/she believes might give rise to any future claim that would fall within the scope of such insurance?
No Yes
If 'Yes', please provide details
12e. Has the Association or any person proposed for insurance ever had similar insurance cancelled or declined to renew, or had special terms imposed in relation to this type of insurance?
No Yes
If 'Yes', please provide details
12f. Has there been, or is there now pending, any prosecution of the Association or its subsidiaries under the Corporations Law, Trade Practices Act, or any other statute?
No Yes
If 'Yes', please provide details
13a. If currently insured, list details of existing insurer:
13b. Current Policy Limit: $ 
13c. Period of Insurance: From   To  
Cover Required
14a. Amount of Total Sum Insured: $ 
14b. Amount of preferred excess (N.B. Your policy will be subject to a minimum excess) $ 
14c. Do you require an Extended Reporting Period? (an additional premium map apply)
No Yes
Directors and officers cover
15. Has any director or executive officer of the Association been declared bankrupt or entered into a deed of assignment, composition or a scheme of arrangement with creditors?
No Yes
If 'Yes', please provide details
16. Has any director or executive officer of the Association been a director of an organisation placed in administration, a scheme of arrangement, receivership, liquidation or provisional liquidation?
No Yes
If 'Yes', please provide details
17. Financial Statements
As part of this proposal please provide the most recent Audited Financial Statements (including balance sheet and income statement)
18. Is there any subsequent information of a material nature not disclosed in the attached financial statements that could affect the financial position, capital structure or operation of the Association?
No Yes
If 'Yes', please provide details
Professional indemnity cover
19. Nature of Business
State fully the nature of any professional services offered by on on behalf of the Association (Please provide copies of any brochures or other documentation which may assist GNG in gaining a better appreciation of the risk being proposed).
20. Does the Association have a gaming licence?
No Yes
Please select Yes or No and give details as requested
21. Does the Association
a) Provide legal, financial, investment or environmental advice?
No Yes
b) Engage in any form of medical treatment, medical advice or scientific or medical research?
No Yes
c) Provide any web hosting or act as an internet service provider?
No Yes
d) Provide computer or information services or web sites with chat lines or bulletin boards or discussion areas where input can be posted by the public at large?
No Yes
e) Promote or provide any form of insurance to your members or act as an insurance agent?
No Yes
f) Engage in actual construction, fabrication, erection or any form of contracting?
No Yes
g) Engage in real estate development?
No Yes
h) Engage in the manufacture, sale or distribution of any product or process or patented production process?
No Yes
If you answered 'Yes' to any of the above, please provide details:
22. What is the actual total gross revenue for the last 12 months? $ 
23. What is the estimated total gross revenue for the next 12 months? $ 
Employment practices cover
24. Please state the number of employees in the following salary ranges
$0 - $35,000
$35,001 - $100,000
Over $100,000
25a. Did you initiate any terminations(s) within the last 2 years?
No Yes
If 'Yes', please state the reason for the termination(s) and the number of full-time and part-time employees terminated
25b. Please state the number of staff turnover for the last 2 years
26. Are written policies in place regarding the following?
a) Equal opportunity?
No Yes
b) Anti-sexual harassment?
No Yes
c) Discrimination?
No Yes
d) Legal procedures to be followed before termination of employment?
No Yes
27. Limit of liability required under this section:
$500,000 $1,000,000 Other
If 'Other' please specify: $ 
Fidelity cover/taxation investigation cover
28 Have you sustained any loss through fraud or dishonesty of any employee?
No Yes
29 Are all cheques required to be signed by at least two different authorised signatures?
No Yes
30. Do you operate a trust account?
No Yes
If 'Yes' do you employ the services of an independent and qualified accountant to audit your trust account?
No Yes
31. Have you ever received a tax audit advice from the Australian Taxation Office?
No Yes
32. Do you employ the services of an independent accountant?
No Yes
If 'Yes', please state their name and address


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: