TOURISM LIABILITY APPLICATION FORM TOUR OPERATORS

Transcription

1 BUSINESS DETAILS TOURISM LIABILITY APPLICATION FORM TOUR OPERATORS Legal Entity: Trading Name: ABN: Number of years you have operated this business: (If less than 3 years please provide details or previous business/tourism experience and attach) Postal Address: Suburb/Town: Post Code: Location of Business: Suburb/Town: Post Code: Contact Name: Ph No: Web Address: INSURANCE HISTORY Current Insurance Company: Policy No: Expiry Date: Have you in any form (ie. sole trader, partnership or company): 1) Suffered a loss/destruction/damage under any insurance policy in the last 5 years? 2) Aware of any claims against you that may be pending? 3) Has any insurer declined, refused to renew, cancel, impose any special terms or conditions to any applicant, a renewal or policy held by you? 4) Have you been declared bankrupt, convicted of a criminal offence, arson, fraud or dishonesty of any kind in the past 10 years? If you answered yes to any of the above questions please provide details CLAIMS HISTORY Description of Claim Date Amount Paid DETAILS OF COVER Period of insurance: From To Limit of liability required (please circle): $10,000,000 $20,000,000

2 TOURISM MEMBERSHIP DETAILS Name of Association or Group: Have you been accredited with the National Tourism Accreditation Program? Have you been accredited with any other Accreditation Program? If Yes, please provide details: Have you undertaken a Risk Management Program? If Yes, With Whom? OPERATIONAL DETAILS Please detail the type/s of Activities that form part of your Operations: Please indicate what type/s of Activities you subcontract out to other Operators: If you engage Subcontractors do you ensure that they carry their own Public Liability Insurance to a Minimum Amount of $10,000,000 Please advise if you are involved in any of the following, by indicating Yes or No or sub contracted Activity Yes No Sub Activity Yes No Sub 4WD Tours Tag-Along Tours number per tour: Bushwalking/Hiking Fishing Camping Shooting/Hunting Hire of Equipment Hire of Vessels Hire of Vehicles Sand-boarding Surfing Pushbikes Motorbike Canoeing/Kayaking White Water Rafting Swimming Snorkelling Scuba Diving Windsurfing/Kiting Jet-skiing Charter Boating Bungy Jumping Para-sailing Abseilling Rock Climbing Camel/Horse Riding If you operate watercraft please complete the Watercraft Risk Analysis details. Does your business operate outside Australia? If yes, please advise details including where, number of Tours and Turnover: Do you provide your own Accommodation? If yes, please advise details: Do you sell Goods to the Public? If yes, please supply details: Tour Operators Liability Application Form 9 th June

3 Do you Provide Alcoholic Drinks? If yes, please supply details: Have you entered into any contractual agreements, eg CALM? If so, who? and are they required to be noted on the policy? Details of any training or instruction given to participants/staff: Qualifications and experience of supervisor/trainer: ESTIMATED TURNOVER AND WAGES Total estimated turnover for the next 12 months $ Estimated gross wages for the next 12 months $ Please provide number of Participants in the last 12 months: Number of Participants expected to attend each Tour: Number of Tours per Season: Length of Season (Months): PROPERTY DETAILS: (Only complete if you maintain an Office Open to the Public) Are the Premises: Owned Leased Construction: Brick Fibro/Wood Other If Other, please provide details: Year Built: If over 50 years of age, Rewired: advise when: Replumbed: Please indicate type of fire protection at premises: Fire hydrants within 30 metres Fire extinguishers Number: Smoke detectors in buildings Number: Sprinkler Systems ADDITIONAL INFORMATION Tour Operators Liability Application Form 9 th June

4 RISK MANAGEMENT DETAILS A camera with film should be available to photograph any accident scene, to assist in the process of loss adjustment 1. Procedures Yes No N/A a) Do you have written Quality Control Procedures? b) Have you obtained a licence from the relevant authority to operate this business from these premises? c) Are all systems regularly maintained in accordance with council &/or manufacturers regulations? d) Do you have First Aid Training & Equipment? e) Do you have an established system and documented procedures for handling incidents? f) Do you have operational communication device (eg Mobile Phone, CB or Satellite Radio)? g) Do you check vehicles and equipment daily for possible faults? h) Do you have participants sign a Release and Acknowledgement Form? Please attach a copy i) Do you issue helmets to Pushbike/Motorbike riders? j) Do you allow smoking on board vehicles or vessels? k) Do you use only recognised 4WD and walking trails within parks and properties? l) Have you obtained written permission from CALM, or if on private property from the Owner? m) Are warning signed erected? Please provide details. n) Do you operate in remote areas/rugged Terrain? If so, please provide details operation and rescue equipment Watercraft Risk Analysis Appendix (only needs to be completed if you are operating watercraft) Type and Number of boats used: Length & Construction: Type & Size of Motor: Maximum designed speed: Are vessels registered with Department of Transport? How many passengers is each vessel licensed to carry? Please advise area of operation: Do you operate only in calm/inland waters? If no, please provide details: Do you provide Food and Drink? If yes, please provide details: Do you issue life jackets, helmets and appropriate protective clothes? Please describe: Tour Operators Liability Application Form 9 th June

5 Please provide details of Skippers experience and qualifications: If vessel/s are operated by customers who dry hire, what instructions/training is offered? Please note that on vessels with motors: Fire Extinguishers are to be kept on board and fuel to be kept in a safe environment. Any refuelling to take place in a safe environment away from participants and third parties IMPORTANT NOTICES The information provided in this proposal may be used to determine terms, conditions and premium applicable DUTY OF DISCLOSURE Before you enter into a contract of general insurance with the Underwriter, you have a duty under the Insurance contracts Act 1984, to disclose to the Underwriter every matter that you know, or could reasonably be expected to know, is relevant to the Underwriter s decision to accept the risk for the insurance and, if so, on what terms. You have the same duty to disclose those matters to the Underwriter before you renew, extend, vary or reinstate a contract of general insurance. Your duty however does not require disclosure of matter: that diminishes the risk to be undertaken by the Underwriter that is common knowledge that the Underwriter knows or, in the ordinary course of its business, ought to know as to which compliance with your duty is waived by the Underwriter NON DISCLOSURE If you fail to comply with your duty of disclosure, the Underwriter may be entitled to reduce their liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent, the Underwriter may also have the option of voiding the Contract from its beginning. DECLARATION BY PROPOSER/S: I/WE, a) have received the Duty of Disclosure notice and other notices accompanying this Proposal and agree to be bound by the terms of the Policy, b) state that the information given in this proposal and any attachment to it is true and correct and all information relevant to the decision and terms of insurance has been given, c) authorise the Underwriter to give to, or obtain from, other insurers or any credit reference service, any information relating to insurance held by me/us or any claim in relation thereto, state where answers on this proposal are not in my/our handwriting they have been checked by me/us and I/we certify they are correct. SIGNATURE OF PROPOSER/S: Date: Date: Tour Operators Liability Application Form 9 th June