Thankyou for participating in the Play Australia Insurance Survey

The purpose of this survey is to leverage the group buying power of Play Australia to reduce costs and improve coverage quality for all members. To explore this opportunity we require underwriting information to share with select insurance companies solely for the purpose of enhancing and developing this scheme. Please rest assured you will not be contacted by any third parties nor added to any mailing lists.

Coverforce is committed to protecting your privacy in accordance with the Privacy Act 1988 (Cth) (the Act) and the Australian Privacy Principles (the Principles). You can read our Privacy Policy here.

Insured Name *

Contact Name *

Email Address *

Years of business experience *

Which state is your business located? *

Number of Directors *

Number of Employees *

Public Liability Insurance

Please provide a description of your business activities *

Estimated annual turnover on a 12-month basis *

Please provide a percentage (%) breakdown of your turnover based on your activities below:

Playground or Play Equipment Manufacturing (Including Alterations)

%

Playground or Play Equipment Construction, Installation or Maintenance

%

Landscaping or surfacing (including Synthetic Playground Surfaces)

%

Design, Consulting, Testing, training, or other professional services for a fee

%

Installation of the Under surfacing and/or foundations

%

Other

%

If Other, please specify activity

Total

%

Do you engage Labour Hire? *

YesNo

What is your estimated annual payments on a 12-month basis?

What activities will be undertaken by the sub-contractors?

What is your current limit of indemnity for your Public Liability policy? *

Please specify

Current Policy Expiry Date *

Who is your current Public Liability Insurer? *

What is your excess/deductibles on your current policy? *

What is your base premium for your current Public Liability policy? *

Claims History

In the last 5 years, have you had any reportable notifications which have been disclosed to your insurer? *

YesNo

Number of notifications

In the last 5 years, have you had any claims which have been disclosed to your insurer? *

YesNo

Number of claims

Date of incident

Date claim was made

Value including indemnity and costs either paid or reserved by your insurer

Professional Indemnity Insurance

Do you provide any advice, consulting, testing, design, training, or other professional services of a skillful nature (other than instructions or warnings provided with a product) that you provide to third parties for an agreed fee, or where you collect revenue specifically for the provision of those services? *

YesNo

Do you require Professional Indemnity Insurance? *

YesNo

Who is your current Professional Indemnity Insurer?

Current Policy Expiry Date

What is your current Limit of Indemnity for your Professional Indemnity Insurance policy?

Please specify

What is your fee income for the last financial year?

What is your excess/deductibles on your current policy?

What is your base premium for your current Professional indemnity policy? *

Please describe your business activities

Please provide details of your qualifications

Claim History

In the last 5 years, have you had any reportable notifications which have been disclosed to your insurer? *

YesNo

Number of notifications

In the last 5 years, have you had any claims which have been disclosed to your insurer? *

YesNo

Number of Claims

Date of Incident

Date of Claim

Value including indemnity and costs either paid or reserved by your insurer

By submitting this form you agree you are authorised to complete this information of behalf of the insured and that all information provided is accurate as at the submission date.