MANAGEMENT LIABILITY INSURANCE APPLICATION

Revenue Details

Total Annual Revenue $

Employee Numbers

                                                           
Please state the total number of employees including self: Yes  No
Do you have written employment practices procedures that are available to each employee?

PLEASE NOTE: EPL DEDUCTIBLE OF $25,000 WILL APPLY

Main Business Activity





In respect of income earned for the current financial year, please provide a breakdown by State:

NSW ACT QLD VIC TAS SA WA NT Overseas
% % % % % % % % %    Total must be 100%   %

Crime / Fidelity Controls

Yes No N/A
1) Are countersignatures required on all cheques?
2) Are dual authorities required for all funds transfers?
3) Is dual authorisation required for any changes to your master creditors list?
4) Is an inventory check undertaken and reconciled by a person who does not participate in the inventory check?

Promotional Code (if relevant):