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Caravan / Tourist Park Insurance

Applicant information

Please complete this form so we can provide you with the most accurate quote possible.

Surname(s)
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Given Name(s)
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Business name
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Registed Business
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ABN
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Taxable %
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Situation Address:
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Postal Address:
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Private Phone No.
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Business Phone No:
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Email
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Website:
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Other interested parties

Type of Interest
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Name:
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Address:
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From
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To:
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Current Insurer:
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General information

(If "Yes", to any questions below, please provide full details including name of insurer, dates, amount in $'s, reason for cancellation):

1. Have you (in the past 5 years)

Made any claim(s) on an insurer for loss or damage?
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Had any insurance declined or cancelled, application rejected, renewal refused, claim rejected, special conditions or excess imposed by an insurer?
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Suffered any loss or damage which would have been covered by the proposed insurance policy?
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2. Have you or any partner(s), share holder(s) or director(s) of the business

Ever been declared bankrupt?
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Ever been involved in a comapny or business which has become insolvent or subject to any form of insolvency administration (e.g. liquidation or receivership)?
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Been covicted of any criminal offence within the past 5 years (other than minor traffic convictions)?
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Been liable for any civil offence or pecuniary penalty (exceeding $5,000)?
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Park information

Occupancy Details of the premises:
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If lessee; are you required under your contractual agreement to insure Property Owners Liability
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If yes, please provide details of the owner:
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Do you have Park Managers:
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If yes, are they Employees or Sub-Contractors?
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Annual Turnover
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Annual Wages
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No. Working Proprietors
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No. Working Employees
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No. Years in this Business
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No. Years in similar Business
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Park Rating
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Are you a member of any of the following Groups/Organisations

Big 4 Holiday Park
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Caravan Park State Association
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Top Tourist Parks
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Family Parks of Australia
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Kui Parks
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Other
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Please advise how many of the following you have:

Un-powered Sites
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Permanent Sites (Full time resident)
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Cabin Sites
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Annual Sites
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Powered Sites
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Other:
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Park activities and services

Please advise what services/activities your park provides

Please advise what services/activities your park provides

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Other activities not listed above
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Do you engage in any other activities that provides any income (i.e. Walking tours, School Camps, Backpackers)
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If yes; please provide full details including income:
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Do you provide transport for patrons
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Business Interruption

Cover Required
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Indemnity Period (please select one)
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Sum Insured

Gross Income (Money payable to you for goods sold/services rendered or rentals, less purchase cost pf stock
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Payroll (Wages paid to employees)
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Claims Preparation Cost (In addition to included Benifit of $5,000)
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Increased Cost of Working
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TOTAL SUM INSURED
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Theft

Cover Required
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Sum Insured

Contents
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Stock (excluding tobacco, cigarettes, cigars & liqour)
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Tobacco, Cigarettes & Cigars
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Liquor
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Theft without Forcible Entry (in addition to included Benefit of $5,000)
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TOTAL SUM INSURED
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Money

Cover Required
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Sum Insured

In Transit
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On Premises - During Normal Business Hours
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On Premises - Outside Normal Business Hours
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On Premises - Outside Normal Business Hours in a Locked Safe or Strongroom
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In Private Residence
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Damage to Safe / Strongroom
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TOTAL SUM INSURED
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Machinery Breakdown

Fire & Perils risks are to be insured under the Property Section. Theft risks are to be insured under the Theft Section

Cover Required
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Do you Require Cover for Breakdown of Machinery, Plant, Boilers & Pressure Vessels ($10,000 Limit)
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Do you Require Cover for Deterioration of Refridgeated Goods
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$ (Insert Required Amount)
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If Yes; please complete the following list and show the number of each type of equipment. Please Note: No plant must exceed 4Kw/5hp.

Air Conditioning Units
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Dryers
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Freezers
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Cool Rooms
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Washing Machines
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Other
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Electrical Equipment

Fire & Perils risks are to be insured under the Property Section. Theft risks are to be insured under the Theft Section

Insured Property - List items including make, model & Serial numbers

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Sum Insured
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Sum Insured
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Sum Insured
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Restoration of Data
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Increase Cost of Working
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TOTAL SUM INSURED
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Liability

Cover Required
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Limit of Indemnity (please select one)
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Other $
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Glass

Cover Required
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Sum Insured

Internal & External Glass
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Temporaray Protection & Shuttering, Sign writing, Damage to Property & Damage to Electrical Signs (in addition to automatic benefit of $5,000)
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General Property

Cover Required
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Type of Cover
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Insured property - list items including make, model and serial numbers
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Unspecified Items ($1,000 Limit any one item/set/pair applies)
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TOTAL SUM INSURED
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Unregisted Mobile Machinery

(i.e. Lawn Mowers, Quad Bikes)

Cover Required
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Machinery Details
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Sum Insured
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Machinery Details
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Sum Insured
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Machinery Details
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Sum Insured
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TOTAL SUM INSURED
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Commercial Motor Vehicle

(i.e. Registered Commercial Vehicles)

Cover Required
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Number of vehicles
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Vehicle 1 details
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Vehicle 2 details
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Vehicle 3 details
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Vehicle 4 details
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Vehicle 5 details
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Vehicle 6 details
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Vehicle 7 details
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Vehicle 8 details
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Vehicle 9 details
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Vehicle 10 details
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TOTAL SUM INSURED
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Spam Check(*)
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Please type the two words into the box above and then select the 'SUBMIT' button.