Not For Profit Insurance
Advice Line
1300 016 599
1
2
3
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5
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Not For Profit Insurance
Advice Line
1300 016 599
1
2
3
4
5
6
Completing this online Proposal Form
Please answer all questions giving full and complete answers.
It is the duty of the proposer to provide all information that is requested in this Proposal Form as well as to disclose relevant facts. A relevant fact is a known fact or circumstances that may influence the evaluation of risk by the insurer. If you are uncertain about what a relevant fact is, please contact us.
If renewing an existing policy with Not For Profit Insurance Brokers, please ensure you check all information and make any necessary changes.
Organisation Information
Type of Organisation
Please select organisation type..
Aged Care
Amateur Sports Club
Animal Welfare/Protection Group
Arts & Culture
Band Association of NSW Member
Businesses and Professional Association
Community Health Centre
Development & Housing Services
Disability Group
Domestic Aid Services, Emergency Relief
Education & Scholarships
Emergency & Safety
Environmental Group
Faith - Christian
Faith - Non-Christian
Family Support Group
Female Support Group
Gay & Lesbian Support Group
General Interest Group
Health & Wellbeing
Heritage Group
Historical Society
Homeless
International Organisation
Libraries & Museum
Male Support Group
Mental Health Support Group
Multicultural Society (excluding Faith / Religious organisations)
Music and Theatre Production
Performing Arts Venue
Philanthropic & Advocacy Services
Recreation Club
Recreational Park or Botanic Garden
Rural & Regional
Science & Technology
Social Club
Youth Support Group
Zoological Park / Wildlife Park
Do you undertake Land Conservation, Land Cleaning, Pest Control, or Controlled Backburning?
Yes
No
Age of Organisation
Select Age..
0-2
2-5
5+
Number of Volunteers and registered Members
Annual Income
$
Please provide an approximate % breakdown of Annual Income by State or Territory according to where it is earned:
Total must be 100%:
NSW
ACT
QLD
VIC
TAS
SA
WA
NT
Overseas
Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?
Yes
No
Yes
No
Is the organisation to be Insured an incorporated &/or registered Not For Profit or Charity?
Period of Insurance
Policy Start Date
