Landcare Insurance Scheme Application

This scheme is designed specifically for not-for-profit Landcare groups that carry out typical Landcare activities. The following is a statement that the scheme is based around which can provide a guideline to the types of activities that this insurance provides cover for:

Community Landcare movement that promotes and advocates for natural resource management and ecologically sustainable development across farmland, bushland, parkland, beaches, national parks, rivers, dunes, creeks, Crown land, public land, private land, forests and travelling stock routes.

Activities include, bush regeneration and weed control; revegetation; repairing eroding gullies and stabilising riverbanks; collecting litter; creating and repairing walking tracks; protecting threatened species; stabilising sand dunes, working with councils on installing litter traps, equipment hire, property ownership conducting workshops, field days, site tours and collaborative learning.

If your organisation’s goals or activities do not fit within the above description, this cover may not be suitable and may leave you at risk.

Contact Name*

First NameLast Name

Position*

Email:*

Best Contact Number*

Alternative Number

Group Name*

Street Address (must not be a PO box)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is your group incorporated?*

YESNO

Are you a current financial member of a Landcare group?*

YESNO

How many staff and/or volunteers are involved in the day to day running of your organisation?*

Up to 20Up to 50Over 50

How many individual volunteers are registered to your organisation over the course of a year?*

Up to 20Up to 50Over 50

Please select the main type of activity your organisation most closely identifies with:*

Will you require a quote for Association Liability?*

YESNOI Don't Know

Community Underwriting's Association Liability Insurance is designed to protect a not for profit or community organisation and its Directors, Office Bearers and voluntary workers for liabilities that arise out of the work of the organisation.

Some of the features of our Association Liability Insurance include:

Employment practices cover (including third party employment practices liability)
Directors & Officers Liability
Professional indemnity cover
Libel and slander cover
Tax audit cover and fidelity cover (including third party crime)
Fines and penalties cover
Loss Of Documents
Outside Directorship Trusteeships and Committees
Investigations costs
Occupational health and safety defence costs
Extended cover for retired Directors and Officers

You can find more information about the cover here, or call Ceneta insurance on 1300 158 911.

EMPLOYMENT PRACTICES: Do you currently have written policies & procedures in place for employees and/or volunteers regarding the following:*

	YES	NO
Equal Opportunity
Anti Sexual Harassment
Discrimination/Bullying
Are formal procedures followed for performance management, complaints & termination?

FIDELITY/CRIME: (relevant to the risk exposures from engaging both employees AND volunteers). *

	YES	NO
Have you sustained any loss through fraud or dishonesty of any employee or volunteer?
Are all cheques / EFT transactions required to be signed by at least two different authorised signatures?
Do you employ the services of an independent accountant?
Are duties segregated so that no individual can control any financial or asset function from commencement to completion?

CLAIMS AND CIRCUMSTANCES:*

	YES	NO
Are there any circumstances not already notified to insurers which may give rise to a claim against the Organisation, or any Office Bearer, Executive Staff, Sub-committee members, employee or volunteers of the Organisation?
Is any person proposed for insurance aware, after enquiry, of any circumstances or incident which he/she believes might give rise to any future claim that would fall within the scope of such insurance?
Has there been, or is there now pending, any prosecution of the Organisation its subsidiaries or any person proposed for this insurance under the Corporations Law, Competition and Consumer Act, or any other statute?

DISCLOSURE:*

	YES	NO
Have you, or any person who will receive insurance protection under the proposed policy, been charged with, or convicted of, any criminal offences in the past 10 years?
Has any director or executive officer of the organisation been declared bankrupt or entered into a deed of assignment, composition or a scheme of arrangement with creditors?
Has any insurer declined an application from you, or cancelled or refused to renew a policy of yours, required special terms to insure you, or declined or refused a claim?
Has the organisation had any claims or circumstances which could give rise to a claim in the last 5 years for ANY of the insurances that are being purchased?

Do you have any interested parties that need to be noted on your insurance? (eg. landlord, financier or other bank loan provider?)

Need other insurance outside of the scheme? (Office, motor vehicle, other assets etc). Please let us know so we can help.

Landcare Insurance Scheme Application

Group Details

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