Security Industry Insurance Application Form

Insurance Commencement Date
Name of Insured (including all subsidiary companies)		Add Field
Postal Address
Description of Business
Phone and Email	Phone	Add another phone number	Email	Add another email
ABN
Location of Premises	Address State Postcode Add Another Location
Other parties to be noted on Schedule and their interest		Add Another Party

Partners/Directors

Name Qualification and Experience

Add Partner/Director

Number of Years Business has been Operating
Security Staff	Full Time		Part Time
	Actual Wages Last Year	$	Actual Turnover Last Year	$
	Estimated Wages This Year	$	Estimated Turnover This Year	$
	Are you a member of a security association?	YesNo
Security Association

Public and Products Liability

What percentage of turnover is derived from the following?

	%		%
Design or alteration of security systems		Traffic Controllers
Installation of security systems		Security training
Service and maintenance of security systems		Education programmes, i.e. self defence etc
Security System Consultants		Use of Firearms
Manufacture of security systems		Firearms Training
Monitoring of Alarms		Use of Dogs
Responding to Alarms		Guard Dog training/breeding and/or sale of dogs
Investigation / Inquiry Agency		Crowd Control - Hotels
Static guarding e.g. Business premises, shopping centres, banks, gate houses		Crowd Control - Concerts
		Crowd Control - Discos
Mobile patrols		Crowd Control - Entertainment Venues
Body Guarding		Crowd Control – Other (Private Events, etc.)
Debt Collecting
Cash Carry
ATM Work

Insurance Cover

Limit of Liability	$
Third Party Goods in your Care Custody and Control (Automatic Cover $50,000)	$
Third Party Keys in your Care Custody and Control (Automatic Cover $50,000)	$
Number of Keys held?
How many sets of keys?
How many staff have set of keys?
What systems are in place for the protection of keys?
During Patrols?
While out of the vehicle?
After Hours?

NB: Whereas Goods in Care, Custody and Control includes indemnity for lost client monies, you will only be indemnified for losses arising from your proven negligence. However there are situations, e.g. armed hold-up, where your client may hold you responsible for lost money although you have not been negligent. Therefore, we strongly advise that if as part of your business you carry monies for clients, you complete the Cash in Transit section of this proposal which provides you indemnity even when not negligent.

Professional Indemnity

Cash In Transit

Do you require cash transit insurance?

YesNo

1. How many carries per week?	$
2. What will be the maximum carry?	$
3. What is the average carry limit?	$
4. For what transit limit (any one vehicle carry) is cover required?	$
5. What will be the maximum pavement limit for which cover is required?	$
6. What was the annual aggregate carry for the past 12months?	$
7. What is the estimated annual aggregate carry for the next 12months?	$
8. Estimated annual revenue/income for the next 12months?	$
9. Actual annual revenue/income for the past 12months?	$
10. Estimated Payments to Sub-Contractors?	$
11. Actual Payments to sub-contractors?	$
12. How many Soft Skin vehicles are used?
13. How many Armoured vehicles are used?
14. Do you require Cash Cover whilst working at Automatic Teller Machine?	YesNo $

Cash in Safe

YesNo

Address where safe is located
Maximum amount to be insured at above location
Construction of Premises at above location	Wall	Roof	Floor

Insurance History

Suffered any loss, destruction or damage for risks to be insured under the proposed policy?	YesNo
Had any Insurer decline any claims submitted?	YesNo
Had any Insurer decline any Proposals submitted?	YesNo
Had any Insurer cancel or refuse to renew a Policy?	YesNo
Had any Insurer require any increased premium or imposed special conditions?	YesNo
Ever been bankrupt?	YesNo
Been convicted of or charged with any civil or criminal offence?	YesNo

Insured's Previous Insurer
Expiry Date

Claims History

Date of Incident		Description of incident
Amount Claim	$	Name of Insurer

Date of Incident		Description of incident
Amount Claim	$	Name of Insurer

Date of Incident		Description of incident
Amount Claim	$	Name of Insurer

Date of Incident		Description of incident
Amount Claim	$	Name of Insurer

Date of Incident		Description of incident
Amount Claim	$	Name of Insurer

Before we begin, we will require your contact information

Nightclub	$	Bar and Nighclub	$
Hotel/ Tavern/Bar	$	Sporting Venue	$
RSL or Clubs	$	Concerts and Music Festivals	$
Function Venues	$	Private Homes	$
Restaurants	$	Unlicensed Venues	$
Corporate Functions	$	Other (provide details)	$

Number of Venues?		Number of Nights Worked
Usual Hours Worked?		Average Number of Guards per Venue?
Duties Performed
Average Crowd Size		Maximum Crowd Size
Do you have Documented Operating Procedures?	YesNo	Are all Guards Inducted at each venue?	YesNo
How Often is Training Conducted?		Years of Crowd Experience

Professional Indemnity Sum	$
For what activities do you require Professional Indemnity?
Subcontractors
Do you use subcontractors?	YesNo
Do subcontractors have their own insurance?	YesNo
Do you sigt their policy?	YesNo
Actual Payments to subcontractors Last Year?	$
Estimated Payments to subcontractors Last Year?	$
What Activities do you use Sub Contractors?
Guard Dogs
Do you require insurance for guard dog security?	YesNo
Are all dogs properly kennelled when not being used for guard duty?	YesNo
Are all dogs professionaly trained prior to being used for guard duty?	YesNo
Firearms
Do you require insurance cover for use of firearms?	YesNo
Are all Firearms Licensed?	YesNo
Number of firearms used
Number of guards licensed to use guards
Are firearms serviced each year?	YesNo
Batons
Do you use batons?	YesNo
Number of batons used
Do you undertake baton training?	YesNo
Other
Do you provide any indemnities, hold harmless conditions to any customers, suppliers or other parties?	YesNo
Do you contract to any State, Federal Authorities or Airports? Please provide details below	YesNo

Make and Model
Thickness of safe walls
Thickness of safe door
Is the safe fixed to the floor?	YesNo
Is the safe drill resistant?	YesNo
Is the safe torch resistant?	YesNo
Is the safe connected to alarm?	YesNo
What is the manufacturer's cash rating on the safe?
How many staff have the keys and combination?
Details of the Security and Alarm System at the above location
Make and Model of Security Alarm System
Back to base/local
How many staff have the Alarm Code?
Areas of premises monitored
Details of Physical security - caged doors, barred windows etc.?
Details of maintenance contract including name of Maintenance Company and frequency

Application for Security Industry Insurance Form