Travel Agent & Intermediary Failure Insurance (TAIFI)

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1 Travel Agent & Intermediary Failure Insurance (TAIFI) For ATAS accredited companies Save Form COMPANY NAME (The Applicant): Tel No: Contact: Address: Fax No: State: Date Established: Website address: Does the Applicant above have a parent company Yes / No ACN No. ABN No. If Yes, please state company name and address Are you ATAS accredited? If NO, please note we can only indicate terms which are subject to your company being successfully accredited by ATAS. You may therefore wish to seek ATAS accreditation before making this application. Are you IATA accredited? ATAS Membership Number: How are you currently protecting your client s money? Please advise tick where appropriate: Other Trust Account Insurance Bond Please specify: Do you have any agency agreements with suppliers? (please list your top 10 suppliers below) Print Form

2 TURNOVER What is your estimated turnover for the next 12 months AUD (per passenger) : Domestic International Estimated Number of passengers travelling: Domestic: International: Average Holiday Cost - AUD (per passenger): Domestic : International : Maximum Holiday Cost - AUD (per passenger): Domestic : International : MERCHANT PROVIDERS Who provides your Credit Card Merchant facilities: Percentage breakdown of Sales (%) by Taken by you Taken directly with supplier CASH % % CHEQUE % % CREDIT CARD % % EFT % % OTHER (please specify) Total Turnover AUD (for each) What is the maximum amount of prepayments held at any one time for bookings (eg. Maximum kept in your client account) TRADING PATTERN Please indicate approximately as a percentage by month January % February % March % April % May % June % July % August % September % October % November % December % BANKER(s) DETAILS Name and address of Banker (s): How long have you been with this Bank?

3 OTHER INTERESTS Are you involved with any other business? If yes, please give details (including name of the company and nature of business) Percentage of business - related to travel: % related to non travel % YOUR DUTY OF DISCLOSURE Before the Applicant enters into a contract with the Insurer, the Applicant has a duty, under the Insurance Contracts Act 1984 (Cth), to disclose to the Insurer every matter that the Applicant knows, or could reasonably be expected to know, is relevant to the Insurer s decision whether to accept the risk of the insurance and, if so, on what terms. The Applicant has the same duty to disclose those matters to the Insurer before an insurance contract is renewed, extended, varied or reinstated. The Applicant's duty however, does not require disclosure of a matter: That diminishes the risk to be undertaken by the Insurer; That is of common knowledge; That the Insurer knows or, in the ordinary course of his business, ought to know; As to which compliance with the Applicant s duty is waived by the Insurer. NON-DISCLOSURE If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce his liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning.

4 DECLARATION I wish to be provided with a quotation for Travel Agent & Intermediary Failure Insurance (TAIFI). I agree that enquiries may be made with various parties in connection with this application. I hereby declare that: I have no reason to doubt that the Applicant will be able to comply with its obligations. To the best of my knowledge, information and belief and after due careful enquiry, the information contained herein is correct. The latest 3 years of accounts, including those of any related body corporate, supplied as part of this application reflect a true picture of the Applicant's financial position and I have no reason to think otherwise. I am not aware of any matter that I know, or could reasonably be expected to know, which I have not disclosed and which would be relevant to the decision whether to accept the risk of this insurance and on what terms. In the event of you issuing the insurance applied for: The Applicant will, upon request during the period of insurance, immediately make available for examination and copying any accounts or other documents in its possession relating to its own, and any related body corporate's financial affairs. I am duly authorised by the Applicant to complete this form on its behalf and to make this declaration on its and my own behalf. I acknowledge the Insurer reserves the right to decline this application and that no cover is in place or implied unless advised in writing by the Insurer I hereby agree personally to indemnify Liberty International Underwriters (LIU) against actions, proceedings, claims and demands which may be brought against it and all liabilities, losses, damages, costs, and expenses of whatsoever nature which LIU may suffer, incur or sustain arising out of a breach of this declaration. I enclose the following: Tick The latest 3 years audited financial accounts, including those of any related body corporate. Please note that if original copies are not submitted, any photocopies must be signed by auditors/ accountants / company official to confirm authenticity. OR The latest 3 years un-audited financial accounts, including those of any related body corporate. Please note that if original copies are not submitted, any photocopies must be signed by authorised company official to confirm authenticity. Copy of current brochure/marketing details/ terms and conditions/booking confirmation. Bank Position statement form (see end of this application for form to print off and supply to your bank for completion and return to Gow-Gates). Payment of AUD 100 non refundable application fee has been made By Credit Card: *Note this application fee will be refunded if a quotation is accepted by you Statement of personal assets and liabilities for any sole trader or partnership signed by Accountant/Auditor. Full name & address of all partners for a partnership. Please ensure everything is enclosed or an explanation why not to avoid any delay in your application In addition for newly formed companies (less than 3 years old) CV of Directors/Partners. Business plan. An opening balance sheet.

5 Signed: Date: Print Position: Private Address: Previous Address (If less than 3 Years at current Address): State: State: This declaration must be signed by a Director, Partner or Proprietor of the above Applicant Company. PLEASE COMPLETE & RETURN TO: Travel Industry Division Gow-Gates Insurance Brokers Pty Ltd Level 8, 491 Kent Street, Sydney NSW POSTAL : GPO Box 4731 Sydney NSW TELEPHONE: / FAX: Privacy We are committed to protecting your privacy. We use the information you provide to advise about and assist with your Insurance needs. We only provide your information to the companies with whom you choose to deal (and their representatives). We do not trade, rent or sell your information. If you do not provide us with full information, we cannot properly advise you and you could breach your duty of disclosure. You can check the information we hold about you at any time by contacting our Privacy officer on (02) For more information about our Privacy Policy please ask us for a copy and /or refer to our website

6 Please forward to your Bankers after completing your company name and signing I hereby authorise International Passenger Protection Ltd and Gow-Gates Insurance Brokers Pty Ltd to receive this fully completed Bank position Statement. I/We agree that you may provide them with any further information they may require. Signature of client: Company Name: BANK POSITION STATEMENT TO BE COMPLETED BY YOUR BANKERS I would confirm that at close of business on mentioned client was as follows: the bank position relating to the above Current account: DR/CR Deposit account Any other accounts DR/CR Details of a bank overdraft facility Please advise details of any charges, calls or debentures held by the bank on or over the assets of the Additional Information 1. If the client has been or is presently using its overdraft please advise: a. How is the overdraft secured? b. Are additional facilities likely to be available with existing security? c. d. If Yes, to what total upper limit? How do you anticipate any additional overdraft facility being secured? 2. a. For approximately how long has the client been actively using its overdraft facility? b. Would you expect the client normally to be at this level of overdraft at this time of year? c. If No approximately what would be the expected overdraft level for this time of year? 3. a. Is it anticipated that the trading position of the client over the next 3 months will bring an increase or decrease in the level of overdraft? Increase / Decrease

7 b. If any increase to what maximum anticipated level? c. d. If a decrease to what level approximately Do you know of any steps being taken to introduce additional funds into the business or action being taken to improve liquidity? If Yes, please provide details: 4. a. Please advise the highest and lowest CR & DR positions over each of the last 12 months on the various accounts Month CURRENT ACCOUNT Highest Lowest DEPOSIT ACCOUNT If Any b. Date account opened: c. Does the client have any funds not held on deposit but invested outside such as money market investments? If so please state amount Comments Please complete all sections before signing and returning this form directly to: Travel Industry Division Gow Gates Insurance Brokers Pty Ltd Level 8, 491 Kent Street, Sydney NSW 2000 / POSTAL : GPO Box 4731 Sydney NSW Signed: Position: For and on behalf of: Branch: Bank Name: Bank Stamp: Save Form Print Form

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