Eisteddfod Quote Application

Eisteddfod Insurance - Request a quote

The AESA Eisteddfod Insurance Scheme is administered by brokers Ceneta Insurance Services and underwritten by Community Underwriting. If you would like a quote, you can select the covers required here and we will email you an obligation-free quote with further details and PDS documents. You need to be a current member of AESA. The insurance program renews every year on 1 May. You can take out insurance at any time during the year but please note that pro rata rates are not available.
General Details
Contact Name*

First NameLast Name
Position/Role*
ie: President/Treasurer/Secretary
Contact Email*
example@example.com
Contact mobile phone*
Name of insured*
This should be the official name of your Eisteddfod group
Registered Address (This must be a street address - no PO boxes please)*

Street Address

Street Address 2

CityState

Post Code
N/AYESNO
YESNO
General Liability Insurance

to protect against legal liability to pay compensation for personal injury to a third party, or damage to property belonging to a third party, and Liability to volunteers who suffer injury whilst volunteering
0 - 500501 - 1,5001501 - 4,000Over 4,000
Voluntary Workers Personal Accident Insurance

Voluntary Workers Personal Accident Insurance provides financial compensation and cover for defined out-of-pocket expenses if an accident results in the injury or death of a volunteer. This is provided that the accident occurred while the volunteer was performing authorised voluntary work on your behalf, or while they were travelling to or from that work.
YESNO
0 - 500501 - 4,000Over 4,000
Association Liability Insurance

Association Liability Insurance is designed to protect a community organisation and its Directors, Officers and voluntary workers for liabilities that arise out of the work of the organisation.
YESNO
0 - 500501 - 4,000Over 4,000
Business Insurance

Property Insurance provides cover for damage to your property, contents, theft, money, electronic breakdown & general (portable) property.
YESNO

CLAIMS AND CIRCUMSTANCES:*

Rows	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:*

Rows	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?

Please provide any further information if required:
What happens next?

We will use your supplied information to prepare your quote. We will then email your quote with supporting documents.

Got questions? We are only a phone call away.

1300 158 911

Ceneta Insurance Services Pty Ltd ABN: 78 133 436 254
Authorised Representative No: AR 332815 of PSC Connect Pty Ltd
ABN 23 141 574 914 | AFS License No 344648
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Eisteddfod Insurance - Request a quote

General Details

General Liability Insurance

Voluntary Workers Personal Accident Insurance

Association Liability Insurance

Business Insurance