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Public/Products Liability and Personal Accident Insurance for Australian National Choral Association members

ANCA Proposal Form

Combined professional indemnity & public liability insurance and personal accident insurance

Please complete this proposal form in full. Upon our receipt of your completed form, a Tax Invoice detailing your payment options will be sent to you. Before completing this form you must read the Notice to the Proposed Insured, as a requirement of the Insurance Contract Act.

Please note that this is a fully online application process, which requires that you provide a valid email address. By pressing submit you consent to receiving documentation relating to this quote via your nominated email address.

DECLARATION AND AGREEMENT
 
1. I acknowledge that I have read, understood and agreed to the Notice to the proposed insured included with this form.

2. I acknowledge that if this application  is accepted, the insurance cover will be subject to the terms and conditions as set out in the Policy Schedule and Policy Wording.

3. I declare that the information contained in this application form is true and correct and that I have not suppressed nor misstated any facts.

4. I acknowledge that Aon values the privacy of personal information and is bound by the Privacy Act 1988 (Clth) when they collect, use, disclose or handle personal information.

5. I acknowledge that Aon collects personal information to offer, provide, manage and administer the services they provide in accordance with Aon’s Privacy Statement.  I consent to the use of my personal information for the purposes shown in the Privacy Statement, and the disclosure of my personal information to, and obtaining personal information from, other parties, including ANCA and those shown in the Privacy Statement, for any of these purposes.

6. If I have disclosed personal or sensitive information about any other person, I confirm that I have obtained consent from that person to disclose to you their personal or sensitive information and have made them aware that you will or may provide their information to other third parties, including the insurer for any of these purposes, and for the purposes, which we or the third parties may use the information for, including those outlined in Aon's Privacy Statement. If I have not obtained consent and authorisation from any other person to disclose their personal or sensitive information to you, I will inform you before providing the relevant information.

7. I declare that I am a current and financial member of the Australian National Choral Association (ANCA) and shall immediately notify Aon if I cease to be a member of ANCA.

8. I authorise Aon to release personal information relating to this insurance to ANCA.
YOUR DETAILS






POSTAL ADDRESS
COMMENCEMENT DATE
INSURANCE STATUS




CLAIMS/CIRCUMSTANCES
NOTE: If you answer Yes to any of the questions below, please provide details on your separated letterhead and email to au.nfp@aon.com. The standard premium may not apply.:




DECLARATION AND AGREEMENT
PRIVACY
  1. Aon is committed to protecting your personal information in accordance with the Australian Privacy Principles under the Privacy Act 1988 (Cth). We collect, use and disclose personal information to offer, promote, provide, manage and administer the many financial services and products we and our group of companies are involved in as set out in the Aon Privacy Notice.

  2. If you are disclosing personal or sensitive information about any other person to Aon, you confirm that you have obtained the consent of that person to disclose to Aon their personal or sensitive information and you have made them aware that Aon will or may disclose their information to third parties that are reasonably necessary to assist in the provision of the relevant services or products. If you have not obtained consent from this other person to disclose their personal or sensitive information to Aon, you will inform us before providing the relevant information to us.
By submitting this form, you acknowledge that you have read the Aon Privacy Notice and agree that we can handle any personal information you have provided to us in the manner set out above.:

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