Photographers Insurance Application Form

To complete this Photographer & Videographer Insurance application, simply answer all questions outlined in the form below. Our team will then be in touch shortly to discuss.

All fields marked with an * are mandatory.

Insured's Details

Full Name *

Trading As (if applicable)

Contact Number *

Email Address *

Address of Premises - Principal Business Location *

Street address *

City *

State *

Postcode *

Address Equipment is usually stored *

Street address *

City *

State *

Postcode *

ABN *

Are you registered with GST? *

YesNo

Please provide a business description including the nature of work carried out *

Number of years in business *

Estimated total staff including working directors (Australia only) *

Estimated turnover for current financial year

Australia

USA/Canada

Other

Total

Estimated turnover for next financial year

Australia

USA/Canada

Other

Total

Are contractors employed to do work on your behalf? *

YesNo

Do you always confirm your contractors are covered under Workers' Compensation and liability insurance when working on your behalf? *

YesNo

Are you always noted as principal(s) on Contractor' Workers' Compensation and liability policy(ies)? *

YesNo

Cover Commencement Date *This is an annual policy providing 12 months of cover from the Commencement Date subject to review, acceptance and payment of the annual premium.

Type of Cover Required

Photographic Equipment Insurance Options

Minimum Excess: $200 each claim. An excess of $500 applies for laptop computers, tablets, mobile phones, PDAs and the like as well as claims made outside of Australia.

* Provides extended cover up to 90 days excluding all countries on the "Do Not Travel" and "Reconsider Your Need To Travel" lists as detailed by the Australian Government Department of Foreign Affairs and Travel website.

Note: This foregoing is only a brief summary of the cover and you are advised to read the Policy Document closely for full details. The Policy Document is available for inspection upon request or from our website www.coverforce.com.au. Cover will not attach until the application is accepted and premium paid.

Section 1: Loss of or Damage to your Equipment

Please note:

This section must be completed including all the equipment to be insured. Please specify the type of cover required for each item.
No item will be deemed of greater value than $500 unless specified in the Schedule.
If you are registered for GST the Sum Insured value should be the GST exclusive amount.
Please exclude Sum Insured value for Drones and Time Lapse equipment. Please contact us for a quote.

Brand & Description of Equipment *

Serial Number *

Sum Insured *

Type of Cover *

AUS/NZ WideAdd WorldwideStudio

Total Sum Insured ($) *

What security protects the equipment at the normal place of storage? *Please note, that a minimum of deadlocks (or equivalent security subject to approval by Coverforce) on all external doors is required.

Please specify *

Optional Extensions

Section 2: Public Liability Cover

Essential protection for all photographers, this covers your liability for claims by members of the public who suffer injury or damage to property while on your premises or while you are working at their premises. You can also include cover for liability for goods in your care, custody or control.

Please note: There is an excess of $500 to each property damage claim. This extension cover does not include USA or Canada. Please contact us if USA or Canada cover is required.

Would you like to include Public Liability cover? *

YesNo

Please select an option:

$5,000,000$10,000,000$20,000,000

Section 3: Professional Indemnity Cover

Professional Indemnity Insurance provides protection when you or your employees are sued for an act, error or omission in relation to professional advice given. Our policy covers damages, compensation, interest and costs, and costs of defence.

Please note: There is an excess of $500 to each claim. This extension does not include USA or Canada. Please contact us if USA or Canada cover is required.

Would you like to include Professional Indemnity cover? *

YesNo

Please select an option: *

$1,000,000

General Insurance History

Does the equipment you wish to insure have any existing damage? *

YesNo

Please provide details *

Have you ever had an insurance application, renewal or policy cancelled or declined? *

YesNo

Please provide details *

Have you ever had special conditions or increased premiums imposed? *

YesNo

Please provide details on the special conditions *

Have you ever been charged with a criminal act? *

YesNo

Please provide details *

Have you had other Insurance Claims (Motor Vehicle, Home, etc.) in the last five (5) years? *

YesNo

Please provide details *

Have you suffered loss or damage to any Photographic Equipment in the last five (5) years (insured or not)? *

YesNo

Please provide details *

Are you now, or have been previously insured? *

YesNo

Insurer *

Expiry *

General Insurance History (For Section 3 PI Cover Only)

Have any claims or complaints ever been made against you? *

YesNo

Please provide details *

Has the proposer been involved in any dispute or arbitration concerning professional fees, advice or services during the past ten years? *

YesNo

Please provide details *

Are you currently engaged in (or about to enter into) civil proceedings of either a professional or personal nature? *

YesNo

Please provide details *

Have you ever been subject to disciplinary proceedings for professional misconduct by a professional society or statutory registration board or been called upon to respond to a complaint? *

YesNo

Please provide details *

Do any of the Directors or Employees, AFTER ENQUIRY, have any grounds for suspecting, or are they aware of any circumstances which might give rise to a claim against the proposer or against any of the present or former directors during the past ten years? *

YesNo

Please provide details *

Has any change by way of merger, takeover or change of name occurred in the past 10 years? *

YesNo

Please provide details *

Is the proposer financially associated with any other firm, other than shown on this form? *

YesNo

Please provide details *

Do you have existing Professional Indemnity Insurance cover? *

YesNo

Insurer *

Policy Expiry *

Your Duty of Disclosure

Before you enter into an insurance contract, which is not a consumer insurance contract (as that term is defined in the Insurance Contracts Act 1984), you have a duty to tell the insurer anything that you know, or could reasonably be expected to know, that may affect the insurer’s decision to insure you and on what terms. You have this duty until the insurer agrees to insure you. You have the same duty before you renew, extend, vary, or reinstate an insurance contract.

You do not need to tell the insurer anything that:

reduces the risk they insure you for; or
is common knowledge; or
the insurer knows, or should know; or
the insurer waives your duty to tell them about.

If you do not tell the insurer anything you are required to, they may cancel your contract, or reduce the amount they will pay you if you make a claim, or both. If your failure to tell the insurer is fraudulent, they may refuse to pay a claim and treat the contract as if it never existed.

Duty to not make a Misrepresentation:

There are specific duties that apply to you when you enter into, vary or extend a consumer insurance contract which is obtained wholly or predominantly for your personal, domestic or household purposes e.g., domestic car, house, travel or accident & illness insurance.

You have a duty under the Insurance Contracts Act 1984 (ICA) to take reasonable care not to make a misrepresentation to the insurer (your duty). Your duty applies only in respect of a policy that is a consumer insurance contract, which is a term defined in the ICA. Your duty applies before you enter into the policy, and also before you renew, extend, vary, or reinstate the policy. Before you do any of these things, you may be required to answer questions and the insurer will use the answers you provide in deciding whether to insure you, and anyone else to be insured under the policy, and on what terms. To ensure you meet your duty, your answers to the questions must be truthful, accurate and complete. If you fail to meet your duty, the insurer may be able to cancel your contract, or reduce the amount it will pay if you make a claim, or both. If your failure is fraudulent, the insurer may be able to refuse to pay a claim and treat the contract as if it never existed.

Before you renew your policy, you have a duty under the Insurance Contracts Act 1984 (ICA) to take reasonable care not to make a misrepresentation to the insurer (your duty). Your duty applies only in respect of your policy that is a consumer insurance contract, which is a term defined in the ICA. This notice includes information you have previously told us that is relevant to your policy, which we passed on to the insurer. The insurer requires you to contact us to tell us if this information is incorrect, or if it has changed. If you do not tell us about a change to something you have previously told us, the insurer will take this to mean that there is no change. To ensure you meet your duty, when you contact us to advise of any information that is incorrect or has changed, the updated information you give us must be truthful, accurate and complete. If you fail to meet your duty, the insurer may be able to cancel your contract, or reduce the amount it will pay if you make a claim, or both. If your failure is fraudulent, the insurer may be able to refuse to pay a claim and treat the contract as if it never existed.

Fraudulent Claims Clause (Australia)

If any claim be in any respect fraudulent or if any fraudulent means or devices be used by You or anyone acting on the Your behalf to obtain any benefit under this Policy, or if any loss under the terms of this agreement be brought about by the wilful act or with the collusion of You, We without prejudice to any other right(s) we might have under this Policy, shall be entitled to refuse to pay such claim.

Electronic Delivery of Documentation

To save you time and paper and improve our services we will be providing all documents electronically (including insurance policies, Product Disclosure Statements, Financial Services Guide and other disclosure documents) by email with PDF attachments to the email address provided.

If you do not wish for us to communicate with you in this way or no longer wish to receive documentation from us electronically or you require a hard copy of any documentation, please contact us on 1300 503 503 or email photography@coverforce.com.au.

Change of Risk or Circumstance

You should advise us as soon as practicable of any change to your normal business as disclosed in the Proposal, such as changes in location, acquisitions and new overseas activities.

Subrogation

Where you have agreed with another person or company, who would otherwise be liable to compensate you for any loss or damage which is covered by the Certificate, that you will not seek to recover such loss or damage from that person, Insurers will not cover you, to the extent permitted by law, for such loss or damage.

Claims Made Contract

Subject to its terms and conditions the Certificate will cover your legal liability for any claim:

first made against you during the Certificate Period;
resulting from any circumstance of which you become aware during the Certificate Period which could give rise to a future claim against you provided you immediately inform us in writing of such circumstances within the Certificate Period.

The Certificate will NOT cover your legal liability resulting from any claim, matter, occurrence or circumstance arising from any act, error or omission committed or alleged to have been committed of which you were aware before commencement of the Certificate Period.

Declaration

Interested parties (e.g. finance companies) *

I acknowledge that I have read the Important Notices attached to this Application Form and that I understand these notices. I acknowledge that if this proposal is accepted that the insurance will be subject to the terms and conditions of the certificate wording and will be subject to my payment of premium. I consent to the use of the personal information about me for the purposes detailed in the privacy statement including disclosure of this information to third parties in connection with this insurance. I declare that the information disclosed in this Application Form is true and correct and that I have not failed to comply with my duty of disclosure nor have I included misleading information or have I suppressed information that may be relevant to the underwriter in considering my proposal for insurance.

Insured's Signature *

Draw signature|Type signatureClear

Date *

General Advice Warning

This document has been prepared without taking into account your objectives, financial situation or needs. You must therefore assess whether it is appropriate, in the light of your own individual circumstances, to act upon this advice.Please refer to the Insurance Product Disclosure Statement (PDS) prior to making any decision to acquire that product.