Sports Underwriting Australia Pty Ltd

Miscellaneous

Your Name:
Your Phone No:
Your Email:
Brokerage Name:
Australian Financial Services Licence No:
Clients Name:
Business Address:
Annual Turnover:
Number of Members:
Current Insurer:
Expiry Date:
Holding Broker:

Do you employ instructors?

Yes NO

Are the premises licensed?

Yes NO

Do you own or operate Pokie Machines?

Yes NO

Please select the property cover you require:

Fire

Yes NO

Business Interruption

Yes NO

Burglary

Yes NO

Money

Yes NO

Glass

Yes NO

Broadform Liability / Professional Indemnity Extension

Yes NO

Machinery Breakdown

Yes NO

Electronic Equipment

Yes NO

General Property

Yes NO

Has the insured had any claims in the past 5 years that would be covered by the proposed insurance?

Yes NO

Is there any other information you would like to provide?

Yes NO

Your Name:
Date:
Please press the submit button. A response will be sent to your nominated email address.