property insurance

Sportscover Gymnasium Insurance Quote Request

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	Sportscover Gymnasium Insurance
	*Contact Name:
	*Organisation Name:
	*Postal Address:
	*Suburb/Town:
	*Postcode/Zipcode::
	*State/County/Province:
	*Country:
	Phone no:
	Fax no:
	Email Address:
	*Sport:
	*Period of Insurance:
	Details of Insurance required
	* Is the centre/gymnasium incorporated? * Does the centre/gymnasium have an A.B.N.? If "yes" what is the centre/gymnasium's A.B.N.? * Is the centre/gymnasium registered for G.S.T? * If applicable, please provide the centre/gymnasium's I.T.C. percentage: * Physical Address of centre/gymnasium: CENTRE/GYMNASIUM ACTIVITIES * Does the centre/gymnasium have:- a) Swimming pool?: Size: m x m b) Plunge pool?: c) Spa?: d) Suana?: c) Solarium?: d) Tennis Courts?: e) Squash/Racquet Ball Courts?: f) i. Weight training(machines)?: ii. Weight training(free weights)?: g) Grand stand?: h) Child Minding facilities?: i) Canteen/Cafeteria?: * Does the centre/gymnasium :- j) Host internatioinal/national events?: k) Own the premises?: l) Manufacture goods?: * Does the centre/gymnasium sell goods to the public?: If "yes", please give details. * How many registered members(active and non-active) does the centre/gymnasium have? Please mark "x" in appropriate answer ( ) 0 - 500 members ( ) 501 - 1000 members ( ) 1001 - 2000 members ( ) 2001 and above members. Please specify amount: * What is the centre/gymnasium's turnover for the previous financial year?: * Is there a policy in place for members or workers with regard to:- Pregnancy?: Blood Spillage?: Infectious diseases?: If "yes", please give details: * Are all instructors qualified? If "yes", give details * Number of instructors to be insured: * Has any Insurer ever declined, refused to renew or imposed special terms and conditions to any application, renewal or policy held by the Proposer?: If "yes", please give details: PUBLIC LIABILITY * Sum Insured (Limit of Indemnity any one occurrence) for the conduct of the Sport / Activities detailed above $ * Aggregate Limit $ $500 Excess PROFESSIONAL INDEMNITY * Sum Insured (Limit of Indemnity any one occurrence) for the conduct of the Sport / Activities detailed above $ * Aggregate Limit $ $500 Excess PROPERTY DETAILS * Approximate age of Premises: years * Construction:- Walls: Roof: Floor: Height: * Are sprinklers installed?: * Are smoke detectors installed?: * Security : Are there :- a) deadlocks on doors & windows?: b) grills on windows?: c) pad bolts on doors and windows?: d) security tapes on windows?: * Security Alarm installed?: If "yes", provide details of type below Local?: Siren?: Monitored?: Alarmed?: Patrol?: FIRE AND PERILS TOTAL SUM INSURED * Building(s) $ * Plant/Machinery & all Contents (Ex Stock) $ * Stock $ * Other: $ * Accidental Damage $5,000.00 * $100 Excess other than as stated in Section Excesses below. * Section Excesses: Accidental/Malicious Damage $250 Earthquake $20,000 / 1% of loss, whichever is the greater BUSINESS INTERRUPTION TOTAL SUM INSURED * Gross Profit / Revenue $ * Claims Preparation Costs $ * Additional Increase in Cost of Working $ * Other: $ * $100 Excess other than as stated in Section Excesses below. * Section Excesses: Accidental/Malicious Damage $250 Earthquake $20,000 / 1% of loss, whichever is the greater * Do you require Payroll to be insured?: * Percentage of Annual Payroll required: Please mark "x" in appropriate answer ( ) 10% ( ) 25% ( ) 50% ( ) 75% THEFT TOTAL SUM INSURED * Stock in trade including clothing $ * Contents including sporting equipment $ * Other: $ * $150 Excess MONEY TOTAL SUM INSURED * Money in Transit $ * Money on Business Premises (Working Hours) $ * Money on Business Premises (Outside working hours) $ * Money in Safe or Strongroom $ * Money in Personal Custody $ * Other $ * $100 Excess GLASS TOTAL SUM INSURED * All External Glass * All Internal & External Glass * Extensions: Temporary Shuttering $750.00 Damage to Frames $750.00 Signwriting $750.00 * $100 Excess
	*Have you had any claims in the past 3 years?	NO YES
	If you clicked "YES" in the previous question, please give details of claims:
	Any other Relevant Information:
	*Name of Agent requesting Quote:
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