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Insurance for Not for Profits and Community Groups

Not For Profit

Insurance Application


Based on the way you have answered our Insurance Puzzle Solver, the following insurance policies are recommended for your organisation:

To complete this application, you should prepare:

The application forms are now set out in a way that make them simpler and easier to complete, however we’d recommend that you have all the information detailed above ready, and give yourself at least 20 minutes to complete the forms. Please note, due to privacy and security reasons, you cannot save your application as you go.

Look out for the ? throughout the application forms – we have provided a helpful and simple explanation of what you should consider when answering that question. However, should you have any further questions while filling out the form, please contact our NFP team on 1800 123 266.

Not For Profit

Information about your organisation


Telephone
How did you find out about Aon and the Insurance Puzzle Solver?

For e.g., from which NFP Peak body or other source?

Period of Insurance
From
at 4pm to
at 4pm (1 year duration) ?
Insured Name
?
Trading Name(if applicable)
?
Is your Organisation Stamp Duty Exempt
?

Your broker will request a copy of this exemption, should you decide to take out this insurance.

Is your Organisation an Incorporated Body
If yes, under what legislation is it incorporated?
?
ABN/ACN/Other Number
Year Established
Street address
?
Postal Address(if Different to Above)
Website Address
Total number of:
Volunteers
Paid Workers
Please provide us with a list of activities your organisation conducts, including those involving paid employees and volunteers.
?

Claims and Disclosure


In the past 7 years, have you made an insurance claim or suffered an uninsured loss for any of the below classes of insurance?
Has any insurer declined a proposal form from you or cancelled or refused to renew your policy or imposed special terms?

Property


Please provide details of each property individually. Should you have more than 5, we'd recommend giving our team a call on 1800 123 266.

How many locations do you want to insure?

?

Location 1 Address:

Sums Insured for Location 1

Fire & Perils - Building (Replacement value)

$

Fire & Perils - Contents (Replacement value)

$

Construction of building ?

If construction type is not 100% one material or the material is not listed, please click 'Other' and detail % breakdown by material type.

Floor

Walls

Roof

What fire protection do you have?

Number of hose reels

Number of extinguishers

What Security do you have?

Security Fencing
Deadlocks on doors
If No, what type of door locks?
Are key locks fitted to windows?
Is a security alarm fitted?
If Yes, is it a monitored alarm?
Is your premises situated in an area connected to town water?
Are there bars on the windows?
Burglary Sum Insured
?

Location 2 Address:

Sums Insured for Location 2

Fire & Perils - Building (Replacement value)

$

Fire & Perils - Contents (Replacement value)

$

Construction of building ?

If construction type is not 100% one material or the material is not listed, please click 'Other' and detail % breakdown by material type.

Floor

Walls

Roof

What fire protection do you have?

Number of hose reels

Number of extinguishers

What Security do you have?

Security Fencing
Deadlocks on doors
If No, what type of door locks?
Are key locks fitted to windows?
Is a security alarm fitted?
If Yes, is it a monitored alarm?
Is your premises situated in an area connected to town water?
Are there bars on the windows?
Burglary Sum Insured
?

Location 3 Address:

Sums Insured for Location 3

Fire & Perils - Building (Replacement value)

$

Fire & Perils - Contents (Replacement value)

$

Construction of building ?

If construction type is not 100% one material or the material is not listed, please click 'Other' and detail % breakdown by material type.

Floor

Walls

Roof

What fire protection do you have?

Number of hose reels

Number of extinguishers

What Security do you have?

Security Fencing
Deadlocks on doors
If No, what type of door locks?
Are key locks fitted to windows?
Is a security alarm fitted?
If Yes, is it a monitored alarm?
Is your premises situated in an area connected to town water?
Are there bars on the windows?
Burglary Sum Insured
?

Location 4 Address:

Sums Insured for Location 4

Fire & Perils - Building (Replacement value)

$

Fire & Perils - Contents (Replacement value)

$

Construction of building ?

If construction type is not 100% one material or the material is not listed, please click 'Other' and detail % breakdown by material type.

Floor

Walls

Roof

What fire protection do you have?

Number of hose reels

Number of extinguishers

What Security do you have?

Security Fencing
Deadlocks on doors
If No, what type of door locks?
Are key locks fitted to windows?
Is a security alarm fitted?
If Yes, is it a monitored alarm?
Is your premises situated in an area connected to town water?
Are there bars on the windows?
Burglary Sum Insured
?

Location 5 Address:

Sums Insured for Location 5

Fire & Perils - Building (Replacement value)

$

Fire & Perils - Contents (Replacement value)

$

Construction of building ?

If construction type is not 100% one material or the material is not listed, please click 'Other' and detail % breakdown by material type.

Floor

Walls

Roof

What fire protection do you have?

Number of hose reels

Number of extinguishers

What Security do you have?

Security Fencing
Deadlocks on doors
If No, what type of door locks?
Are key locks fitted to windows?
Is a security alarm fitted?
If Yes, is it a monitored alarm?
Is your premises situated in an area connected to town water?
Are there bars on the windows?
Burglary Sum Insured
?
Money in transit / on premises, etc.
?
Do you require cover for Glass (Replacement Value)? ?
Do you require cover for Machinery Breakdown? ?
Sum Insured
$
Excess required
Do you require Deterioration of Stock Only? ?
Sum Insured
$
Do you require Computer & Electronic Breakdown cover? ?
Sum Insured
$
Excess required
Do you require cover for Reinstatement of Electronic Data? ?
Sum Insured
$
Excess required

Is General Property away from the premises or Special Contingency cover required?

Sum insured limit
$
?

Portable equipment is insured anywhere in Australia. Should you require this cover, your broker will request a list and value of these items.

Employee Dishonesty ?

Do you require cover for Employee Dishonesty

Business Interruption


Please state the amount of cover you require for Business Interruption / Consequential Loss:
$
?

Public Liability

About Your Organisation


Limit of Indemnity Required
(Please Select One)
 
No. of staff
Estimated annual payroll
Managerial, Directors, Clerical and Sales
$
Manual Employeees
$
Manufacturing/Installation
$
Other
$

Estimated Funding for Current Financial Year

Government Fund Raising
$
Donations
$
Other
$
  
Total
$

Details of the Business/Premises

Do you have representation outside of Australia?
?

Where and what is the nature of your representation in such country (e.g. domicile employee, power of attorney, branch subsidiary agency, etc.)?

Number of years in this business

Location of premises occupied for the purpose of conducting the business

Location of Premises owned BUT not occupied by you for which property owners cover is required
Type of building e.g. shopping centre, office etc.

Does your organisation or anyone on your organisation’s behalf, manage, own, offer, or be in anyway connected with the following?

Please Provide details
First aid Facility
Pressure Vessels
Car Parks
Lifts, Escalators, Hoists, Cranes
Unregistered Vehicles
Railway e.g. sidings

Further details about your organisation

Do you have to be licensed for any of your business activities?

Please confirm licenses in the space provided below

Do all staff/volunteers hold the relevant qualifications to perform their duties?

Please confirm qualifications in the space provided below

Does the organisation have risk management procedures in place?

Please provide details of those procedures below:

As an organisation, do you maintain a record of incidents/events that may give rise to a claim against your organisation?
If yes how long are these records kept?
Do you manufacture any products?

Public Liability

Core Activities


Is your organisation involved in any of the following activities or operate any of the following services?

Transporting clients

Does your organisation provide Transportation of clients throughout the business?

Overnight Accommodation ?

Is overnight accommodation provided?

Daycare / Aged Care / Child Care / Before & After School Care / Vacation Care

Is a daycare service provided? (Including, but not limited to daycare for the elderly, frail, disabled as well as children before or after school and during vacations.)


Tourist Information Centres /Museums/Historical Societies

Does your organisation run a tourist information, museum or historical society?

Seniors Clubs / Neighbourhood Centres ?

Do you operate a Seniors Club / Neighbourhood Centre?

Home Visits ?

Do you conduct Home visits?

Food Services  ?

Do you provide a Food Service?

Support Groups (i.e. Landcare, Lobby, Advocacy)  ?

Are you a Support Group?

Employment Placement ?

Do you place people in employment elsewhere?

Contractual Liability & Hold Harmless Clauses

Coverage of liability assumed under agreement or contract will be limited to lease liability or liability assumed under a warranty of fitness or quality as regards your products, or specifically agreed contracts.

Do you assume liability under contract or hold others harmless (other than lease liability)?

(check the insurance or indemnity section of contracts for words such as "hold harmless" or "agree to idemnify")

Public Liability

Events


Smaller Events

Do you hold events with fewer than 250 attendees? ?

Stalls

Does your organisation hold any stalls Yes/No?


Major Events ?

Please only complete for those events which you will be holding before your next renewal date in a years time.

Do you hold events with more than 250 attendees?

Will alcohol be sold at any events?

Association / Protector Liability

Combined Professional Indemnity and Directors & Officers


Limit of Liability required

$1m
$2m
$5m
$10m
$20m
Higher limits on application ?
Retroactive date (if any)

Financial Position of the Association ?

A. Has there been any change in the financial position of the Association since the publication of the annual report that might materially affect the financial position shown in that report?
B. Is any proposed Insured Person aware of facts or circumstances that might affect the ability of the Association to meet all its debts as and when they fall due?

If the answers is "Yes" to either (A) and/or (B), please supply details below

Financial Statements
Profit/Loss
$
$
Total Gross Revenue/Fees
(including funding)
$
$
Total Assets
$
$
Total Liabilities
$
$

If your Gross Revenue/Funding or assets exceed $5,000,000 or, your total liabilities exceed your total assets, your broker will request your most recent Annual/Financial Report. If your Annual Report/Financial Statements are more than 6 months old, your broker will also request your most recent interim.

Please state number of:

Paid employees
National Office
State/Local Office
Executive staff, secretaries, clerical or technical staff
All other employees
Volunteers
Office Bearers (excluding sub-committees)
Sub-committee members
Approximate number of members in your organisation

Directors & Officers and Board or Committee Members & Association Claims History

Have any claims ever been made against the office bearers, executive staff, sub-committee members of your organisation during the past five (5) years?

Are you aware, after enquiry, of any circumstances which may result in any claim against the office bearers, executive staff, sub-committee members, employees of your organisation?

Have any losses been incurred by the office bearers of your organisation which could have been the subject of claims under an Association liability policy had it been in force?

Has any insurer ever declined, cancelled or imposed special conditions in relation to this type of insurance?

If you have answered "Yes" to any of the above, please supply details below:

Does the Association

A. Provide any legal, financial, counselling or environmental advice?
B. Provide any professional services (other than services provided to members) that are provided on a 'fee for service' basis?
If you have answered ‘Yes’ to A and/or B above, please provide full details of the type of advice and your qualifications/experience.
C. Issue instructional publications or broadcast on television or radio?
D. Organise protests, marches, demonstrations or lobby groups?
E. Provide any aviation services (including flight co-ordination, flight planning or the piloting of any aircraft)?
If you have answered ‘Yes’ to C, D and/or E above, please provide full details.

Motor Comprehensive


Please list all vehicles owned by your organisation.
Number of vehicles

Only list vehicles that the business owns. If you wish to insure vehicles owned by volunteers or staff, you’ll need to provide details on the Motor Non-Owned form.