On-line Sporting or Social Club (Excl. Participation) Public and Products Liability Insurance


Thank you for considering our on-line sporting or social club public and products 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 sporting or social club public and products 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.


Limit of Liability Required:
1a. Please select the amount of Liability cover required:
$5,000,000 $10,000,000 $15,000,000 $20,000,000
1b.
Public Liability (any one occurrence)
Products Liability (each Period of Insurance)
2. Do you currently have Public Liability insurance?
Yes No
If Yes, please provide details below:
Expiry Date
Insurance Company
Indemnity limit $
Excess $
Premium $
Business Details:
3. Brief description of the club:
4. Location:
5. Number of years in this business under this name:
6. Previous industry experience if less than five years in business:
7. Hours of operation:
8. Details of all claims or incidents in the past 5 years (incl. Contributing deductibles):
9. Existing deductible: $
10. Estimated annual Turnover, split by source:
Total Annual Turnover $
Fees $
Bar Revenue $
Food sales $
TAB $
Gaming $
Other (please describe) $
11. Estimated annual wages: $
12a. Number of full time staff:
12b. Number of part time staff:
13. Are Labour Hire personnel engaged by the Insured under a Contract of Service?
Yes No
If Yes, please advise estimated payments to such personnel and the activities performed:
14. Do hired personnel work under the supervision of the Insured or that of the provider?
Insured Provider
15. Are Contractors or Sub Contractors engaged by the Insured?
Yes No
If Yes, please advise estimated payments to such personnel and the activities performed:
16. Are all contractors checked for the existence of Liability cover top a minimum of $5m?
Yes No
17. Estimated percentage of payroll split between work at and away from your own premises:
At premises: % $
Away from premises: % $
18. Is work performed away from your premises?
Yes No
If Yes, please provide details of such work, including duties undertaken, sites worked on and estimated % of turnover derived from such work:
19. Do you agree to indemnify or hold harmless any other parties, by written agreement or otherwise?
Yes No
20. Limit of Indemnity: $
21. Does the Club provide Sporting or Swimming facilities?
Yes No
If Yes, please provide full details of amenities provided, including the number of courts, pitches or venues used, diving boards and water slides along with any other relevant comment:
22. Please provide details of entertainment, (such as disco's, live bands, catering and social events), including average attendance, age groups involved and frequency of events:
23. Does the club have a dance floor?
Yes No
If Yes, what number is there, what area are they and how often is the floor checked and resurfaced?
24a. Is there a "responsible Serving of Alcohol" policy in place?
Yes No
24b. Are all relevant staff required to have training in such policy?
Yes No
Details of premises:
25a. Age of building:
25b. Construction:
25c. Number of storeys:
25d. Number of Car Park spaces:
25e. Is video surveillance performed?
Yes No
If Yes, in what areas and for what periods? How long are copies of records retained?
25f. Restaurant/Dining areas - seating capacity:
25g. Security personnel on premises:
25h. Are the security personnel staff members or sub contractors?
Staff Members Sub Contractors


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: