[TEST] Victorian Woodworkers Association Inc – Craftworkers Liability Insurance Application — Victorian Woodworkers Association

VWA No

Details of Person/Insured

First name *

Last name *

Name of Business *

ABN (if applicable)

Address

Postal address *

City *

State *

Postcode *

Contact details

Email *

Phone

Mobile *

Web/Socials

History

1. Have you or any person associated with your activities made a Liability claim in the last 5 years? *

2. Have you or any person associated with your activities had an insurance claim of any type refused or reduced in the last 5 years? *

3. Have you or any person associated with your activities been refused/declined insurance in the last 5 years? *

4. Have you or any person associated with your activities been charged with a crime of any type &/or bankrupt? *

If yes to questions 1–4, please provide details: *

Limit of Liability *

$10,000,000 Public and Products Liability – $225
$20,000,000 Public and Products Liability – $245

Period of Insurance: 12 months
Approval will only commence from the time the application form has been received by City Rural Insurance Brokers Pty Ltd and acceptance confirmed, subject to the details provided meeting with the insurer’s acceptance criteria. Consequent to approval, cover will only commence from the time the VWA Full Membership Application and payment of the annual Full Membership subscription has been received by the Victorian Woodworkers Association Inc.

Business activities

Please provide the full list of handmade items *

(Note: non-craft products or products made by third parties are not covered)

Location of premises where craft activity is carried out *

Number of people involved in the business apart from the insured *

If teaching, number of people per workshop/class

Estimated income per annum *

Do you import or export any product? *

If Yes, please provide a detailed list of each product imported /exported and the country of origin/destination: *

Duty of disclosure

Your duty of disclosure
Before you enter into an insurance contract, you have a duty to tell the insurer anything that you know, or could reasonably be expected to know, that may affect the insurer’s decision to insure you and on what terms.

You have this duty until the insurer agrees to insure you.
You have the same duty before you renew, extend, vary, or reinstate an insurance contract.
You do not need to tell the insurer anything that:
- • reduces the risk they insure you for; or
- • is common knowledge; or
- • the insurer knows, or should know; or
- • the insurer waives your duty to tell them about.

If you do not tell the insurer something
If you do not tell the insurer anything you are required to, they may cancel your contract, or reduce the amount they will pay you if you make a claim, or both. If your failure to tell the insurer is fraudulent, they may refuse to pay a claim and treat the contract as if it never existed.

I have read and understand the Duty of Disclosure *

Yes

Is there anything more you need to disclose to us? *

If Yes, please provide details stating what it is that you think we ought to know: *

Declaration *

I declare that the information provided above is true and correct

Yes