Tour Operator Liability Insurance

Period of Insurance At 4:00 pm

to

Name of Insured (inc. all Subsidiary Companies)

Postal Address

Suburb

State

Postcode

ABN

Taxable (GST Input)

Full Name

Private Phone

Business Phone

Mobile Phone

Fax

Email Address

Website

Years In Business

Business Location

Additional Business Location

Interested Parties

Above Parties Interest

Criminal Defence Expenses

Yes No

Workcover Defence Expenses

Yes No

Please Describe Your Business Activities

Operation Hours / Days

Please provide Your actual total Turnover for the previous Period of Insurance

$

Please provide Your estimated total Turnover for the coming Period of Insurance

$

Please provide details of Your estimated Turnover as a percentage per State.

Do You sell or distribute any products? If Yes, please complete the Products module Questionnaire

Yes No

Please provide details of the types of Tours You conduct

Please provide details of the estimated number of Tours for the Period or Insurance

Please provide details of the estimated number of Participants per tour

Please provide details of the Ratio of Operators/Instructors to Participants

Land Based?

Yes No

Coastal?

Yes No

Deep Water?

Yes No

Do You utilise the services of contractors / subcontractors?

Yes No

If Yes, what services do they provide?

What are the estimated payments to contractors/ sub contractors?

$

Do You keep and maintain a written record of their Public Liability insurance? (This should carry a minimum limit of $10,000,000 with an authorised Insurer.)

Yes No

Please provide details of all vehicles/vessels

Is the passenger conveyance on tracks or steered by a driver?

What is the maximum speed of the passenger conveyance?

Do You hire out vehicles/vessels?

Yes No

Do all vehicles/vessels carry appropriate Third Party Insurance?

Yes No

Are overnight adventure Tours conducted?

Yes No

Do You provide accommodation?

Yes No

Do You have contingency plans in the event of inclement weather?

Yes No

Do You assess the ability of Participants prior to conducting adventure type Activities?

Yes No

Do You conduct personnel checks/head counts at all stops and check points?

Yes No

For Bike and/or Riding Tours - Are Australian Standards approved Bike Helmets provided and worn at all times in accordance with applicable State Legislation?

Yes No

Do You carry appropriate communication devices (such as CB Radios, Two-way Radios and/or Mobile Phones) at all times?

Yes No

Do You undertake a pre-check programme and keep a written log of same?

Yes No

Do You have a written maintenance and service programme and keep a log of same?

Yes No

Do You keep and maintain an incident report procedure and log?

Yes No

Do You have a written Risk Management programme?

Yes No

Do You have the appropriate current accreditation in Risk Management and Occupational Health and Safety?

Yes No

Do You comply with all relevant Australian/New Zealand Standards and legislation that pertain to Your Business?

Yes No

Are all participants trained in safety procedures?

Yes No

Do You ensure that persons who are under the influence of alcohol are prevented from participating?

Yes No

Do You and all of Your employees, contractors and subcontractors comply with relevant Child Protection Legislation?

Yes No

Are all persons made aware of dangers before participating?

Yes No

Do You ensure that disclaimers are signed prior to participation?

Yes No

Do You have suitable first aid equipment?

Yes No

Are personnel appropriately trained in its application?

Yes No

Your Current Insurer

Expiry Date

Have You or any other party noted as the Named Insured ever had insurance refused or cancelled or has any Insurer ever imposed special terms, conditions or restrictions on Your policies?

Yes No

Please provide full details

Detail all insurance claims made in the last five years. Please include dates and amounts

Are You aware of any uninsured losses or unreported incidents that may give rise to a claim?

A) Has there been, or is there now pending, any action, litigation or other proceedings (Criminal or Civil) against any a) proposed Insured Person, in their capacity as a director, officer, secretary, board or committee member or employee of either the Named Insured or any other company, organisation, association or trust?

Yes No

B) Has there been or is there now pending any investigation, examination, inquiry or other proceedings in relation to the affairs of the Named Insured?

Yes No

C) Do any circumstances exist that may give rise to any event described under a) or b) above?

Yes No

D) Have You or any partner(s), board or committee member(s) of the business ever been declared bankrupt?

Yes No

E) Have You or any partner(s), board or committee member(s) of the business ever been involved in a company or business which became insolvent or subject to any form of insolvency administration (e.g. liquidation or receivership)?

Yes No

If You have answered “Yes” to part a), b), c), d) or e) above, please supply details.