On-line Scuba Instructor Liability Insurance


Thank you for considering our on-line 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 scuba instructor 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.


1. Total Sum Insured and Excess:
$ Total Sum Insured $ Excess
a) Policy One - Professional Indemnity $5,000,000 $500
b) Policy Two - Public/Products Liability $10,000,000 $500 property damage claims only
2. Occupation for which this insurance is required. Please check the appropriate box or boxes
Snorkel Swimming Instructor
Snorkel Diving Instructor
Dive Master
Scuba Instructors
Other
3a. Do you currently hold professional indemnity and/or liability insurance?
Yes No
3b. If you are not currently insured, have you ever held professional indemnity and/or liability insurance?
Yes No
If the answer to either of the above is "Yes",please complete the table below for the past 2 years you were insured.
Name of Insurer Period Insured Type of Cover $ Sum Insured $ Excess
4. Have you ever had a professional indemnity or liability insurer decline a proposal, impose special terms, decline to renew or cancel your insurance?
Yes No
If the answer is "Yes", Please provide details
5. Please enter the full nature of the activities to be covered and type of advice given
6. Name (full legal name of each natural person and incorporated body to be insured as well as any unincorporated business or trading names)
Date(s) of commencement
7. Particulars of all Principals and Directors
Years Practising
Name of Principal/Director Age Qualifications Current Business
Practices		 Previous Business
Practices		 Name of Previous
Business Practices
Resume/CV: If not contained on your website, please copy & paste or email a brief resume for each Principal and/or Director.
8. Total number of:
(a) Qualified staff-including Principals
(b) Other technical staff
(c) Non-technical staff (including typists, receptionists etc.)
Total of all staff
9. Have you amalgamated or merged with any other business?
Yes No
If yes, please provide details:
10. Is any Partner, Principal or Director connected or associated (financially or otherwise) with any other business?
Yes No
If yes, please provide details:
11. Please provide the following information:
$ Australia/NZ $ Overseas
a) Gross professional fees earned for the past 12 months.
(include fees paid to consultants, sub-contractors and
agents appointed by you).
b) Estimated gross professional fees for the next 12 months.
(include in the estimate fees expected to be paid to
consultants, sub-contractors and agents appointed by you).
c) Gross turnover (including all AU$ from sales, manufacture
or installation) for the last 12 months.
d) Estimated gross turnover (including all revenue from sales,
manufacture or installation) for the next 12 months.
12. Please estimate the number of students your business:
Taught over last 12 months Will teach over next 12 Months
a. Snorkelling
b. Introductory scuba diving
c. Open Water Scuba
d. Advanced
e. Rescue
f. Deep
g. Other specialties, please specify  
h. Assistant Instructor
i. Instructor
Total
13. Do you wish to cover your consultants, sub-contractors or agents, in respect of work performed on your behalf?
Yes No
If Yes, a) Please give details of the nature of work performed and the names of all consultants, sub
contractors and agents to be covered.
b) Please state the gross professional fees paid to consultants, sub-contractors and agents to be covered, during the past 12 months.
14. Have you ever undertaken, or are you likely to undertake, work outside of Australia and New Zealand?, If the answer is "Yes", please give details below
Yes No
Country Date of
completion		 $ Annual income Type of work
15. Please state the approximate percentage of Your activities (based on income) applicable to each State, Territory and Overseas.
NSW  VIC  QLD  SA  WA  TAS  NT  ACT  O/S
%  %  %  %  %  %  %  %  %
Please answer the following questions after enquiry within your organisation.
16. During the past 10 years, has any claim been made or has negligence been alleged, against you or any of the present or former Principals, or have any circumstances which may result in a claim, been notified to insurers?
Yes No
If the answer is "Yes", please give details below
Year notified Insured with Claimant Nature of problem $ Amount paid /
outstanding
17. Are there any circumstances not already notified to insurers which may give rise to a claim against you or any prior corporate practice or any of the present or former Principals?
Yes No
If the answer is "Yes", please give details below
Name of Practice and Principal Claimant Nature of problem $ Estimate
18. Are there any claims against previous practices conducted by a Principal, which may give rise to a claim against either a Principal or you?
Yes No
If the answer is "Yes", please give details below
Name of Business/Principal Claimant Nature of problem $ Amount paid /
outstanding
19. Are you an AUSI Instructor?
Yes No
If Yes, Please state AUSI Number and Level

If No, Please state Agency, Instructor Number and Level
20. Do you intend to the use the AUSI Scuba system exclusively and follow AUSI Standards and Procedures?
Yes No
If No, please provide details
21. Do you protect against student and divers own health conditions?
Yes No
If Yes, how?
22. What are the usual age groups of your students?
23. What is the usual instructor student ratio used by you?
a. Pool or confined water training
b. Ocean diving
c. Classroom
24. How long does each skills training session usually last?
25. What is the maximum depth for diving instruction using compressed air?
26. Do you complete a student record for each training session (pool, classroom and ocean) and dive for each student?
Yes No
27. How far offshore does the diving instruction usually take place?
28. Is all diving equipment usually supplied by you?
Yes No
If No, please provide details
29. Do you conduct scuba training using gas mixtures other than compressed air?
Yes No
If Yes, please provide details


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: Date of Commencement
Are you registered for GST purposes?
Yes No
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: