City Rural Insurance Brokers

This insurance is available to persons who regard themselves as Buskers, Street Performers, incl. Musicians & Singers (excluding Bands), Comedians, Jugglers, Magicians, Clowns, Face Painters, Mime Actors, Spruikers, Dancers, Puppeteers, Costume Characters, Balloon Artists, Temporary Spray on and Henna Tattoos, Palm Readers and Tarot Card Readers.

Personal Information

First Name *

Surname *

Address *

Suburb *

State *

Postcode *

Email Address *

Phone

Fax

Mobile Phone

Preferred method of contact *
emailphonemobilefax

Occupation

Insurance Details

Period of Insurance - From *

Period of Insurance - To *

Are you or have you previously been insured against the risks to be insured? *yesno

Have you had any claims made against you (whether insured or not)? *yesno

Have you had any incident or accident occur which would have been covered by the proposed insurance policy? *yesno

Have you had any insurance declined or cancelled, proposal rejected, renewal refused, claim rejected, special conditions or special excess imposed by an insurer? *yesno

Have you ever been convicted of a criminal offence? *yesno

If Yes to any of the above, please provide full details:

Estimated total number of performers:
IndividualDuoTrioOther

If Other, how many?

Please provide details of your activities:

Would you like a quote on * -
Limit Required - Please Select$10,000,000 Public and Products Liability$20,000,000 Public and Products Liabilityboth please

Additional Information:

Contractual Liability
This policy does not cover liability in respect of Contractual liability: Any obligation assumed by You under any agreement or contract except to the extent that:

1. the liability would have been implied by law;
2. the liability arises from a provision in a contract for lease or real or personal property other than a provision which obliges You to effect insurance or provide
   indemnity in respect of the subject matter of that contract;
3. the liability is assumed by You under a warranty of fitness or quality as regards to Your Products;
4. the obligation is assumed under those agreement specified in the Schedule

Duty of Disclosure

In order to make an informed assessment of the risk and calculate the appropriate premium, your insurer needs information about the risk you are asking it to insure.

For this reason, before you enter into a contract of insurance, you have a duty under the Insurance Contracts Act 1984 to disclose to your insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer’s decision whether to accept the risk and, if so, on what terms. The duty also applies when you renew, extend, vary or reinstate a contract of insurance.
You do not have to disclose anything that:

• Reduces the risk to be undertaken by the insurer;
• Is common knowledge;
• Your insurer knows, or in the ordinary course of its business, ought to know; or
• If the insurer has waived your obligation to disclose.

If you do not comply with your duty of disclosure, your insurer may be entitled to reduce its liability in respect of a claim or may cancel your contract of insurance. If the non-disclosure was fraudulent, the insurer may be able to avoid (or cancel) the contract of insurance from its beginning. This would have the effect that you were never insured.

One important matter to be disclosed is the history of losses suffered by the person seeking insurance or any closely associated person or entity. As you are responsible for checking that you have made complete disclosure, we suggest that you keep an up to date record of all such losses and claims.

I have read the Duty of Disclosure above. *